Healthcare Provider Details

I. General information

NPI: 1972720647
Provider Name (Legal Business Name): MALONE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 30TH AVE SUITE 2
KENOSHA WI
53144-1411
US

IV. Provider business mailing address

2305 30TH AVE SUITE 2
KENOSHA WI
53144-1411
US

V. Phone/Fax

Practice location:
  • Phone: 262-597-9700
  • Fax: 262-597-9977
Mailing address:
  • Phone: 262-597-9700
  • Fax: 262-597-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number3473-012
License Number StateWI

VIII. Authorized Official

Name: DR. JEFFREY T MALONE
Title or Position: DOCTOR
Credential: DC
Phone: 262-597-9700