Healthcare Provider Details

I. General information

NPI: 1881583391
Provider Name (Legal Business Name): ANDREW MATTHEW MALOCU DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 LAWNDALE DR
GREENSBORO NC
27455-1889
US

IV. Provider business mailing address

4113 LAWNDALE DR
GREENSBORO NC
27455-1889
US

V. Phone/Fax

Practice location:
  • Phone: 363-814-2366
  • Fax: 336-235-0754
Mailing address:
  • Phone: 363-814-2366
  • Fax: 336-235-0754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5928
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: