Healthcare Provider Details

I. General information

NPI: 1992945588
Provider Name (Legal Business Name): MALINE FAMILY CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ARBUTUS AVE
MANISTIQUE MI
49854-1453
US

IV. Provider business mailing address

127 ARBUTUS AVE
MANISTIQUE MI
49854-1453
US

V. Phone/Fax

Practice location:
  • Phone: 906-341-6601
  • Fax: 906-341-5134
Mailing address:
  • Phone: 906-341-6601
  • Fax: 906-341-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number2301010177
License Number StateMI

VIII. Authorized Official

Name: DR. JONATHAN C MALINE
Title or Position: DOCTOR
Credential: DC
Phone: 906-341-6601