Healthcare Provider Details

I. General information

NPI: 1376934075
Provider Name (Legal Business Name): MALETTA CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 W SHORE DR STE 114
HOLLAND MI
49424-9576
US

IV. Provider business mailing address

2863 W SHORE DR STE 114
HOLLAND MI
49424-9576
US

V. Phone/Fax

Practice location:
  • Phone: 616-399-6624
  • Fax:
Mailing address:
  • Phone: 616-399-6624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010295
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: PHILLIP MALETTA
Title or Position: MANAGER
Credential: DC
Phone: 616-399-6624