Healthcare Provider Details

I. General information

NPI: 1760557169
Provider Name (Legal Business Name): MICHAEL W MALEY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6310 MARKET AVE N
CANTON OH
44721-3127
US

IV. Provider business mailing address

6310 MARKET AVE N
CANTON OH
44721-3127
US

V. Phone/Fax

Practice location:
  • Phone: 330-768-7737
  • Fax: 330-494-8195
Mailing address:
  • Phone: 330-768-7737
  • Fax: 330-452-9636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1232
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1232
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: