Healthcare Provider Details

I. General information

NPI: 1982722070
Provider Name (Legal Business Name): MALIA LEIGH NORDMAN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MALIA LEIGH ROBERTS D.C.

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 LAWNDALE LN
SNEADS FERRY NC
28460
US

IV. Provider business mailing address

126 LAWNDALE LN
SNEADS FERRY NC
28460
US

V. Phone/Fax

Practice location:
  • Phone: 949-201-5323
  • Fax:
Mailing address:
  • Phone: 949-201-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3665
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: