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General NPI Number Information
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NPI Number | 1629518972
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Entity Type | Individual
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Provider Name | BRIAN MALLOY D.C
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Gender | Male
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 200 E ARCH ST STE 102
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City | POTTSVILLE
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State | PA
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Zip | 17901-2982
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Country | US
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Telephone | 570-622-0809
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Fax | 236-936-2811
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Provider Business Mailing Address
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Address Line | 509 EHRET RD
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City | FAIRLESS HILLS
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State | PA
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Zip | 19030-3611
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Country | US
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Telephone | 267-994-0759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH12087
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License Number State | FL
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