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NPI Code Detail

MEDICARE: DR. EMILY SAMANTHA MALLON D.C.

MEDICARE:  DR. EMILY SAMANTHA MALLON  D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor038-010671IL
2111N00000XChiropractor895WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154376291
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY SAMANTHA MALLON D.C.
Provider Business Mailing Address
First Line : 36 FOUNDERS WAY
Second Line :
City : MORGANTOWN
State : WV
Zip : 26508-1102
Country : US
Telephone Number : 517-285-0417
Fax Number :
Provider Business Practice Location Address
First Line : 15630 N PRESTON HWY
Second Line :
City : BRUCETON MILLS
State : WV
Zip : 26525-7036
Country : US
Telephone Number : 517-285-0417
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 08/01/2024

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Directions to “ DR. EMILY SAMANTHA MALLON D.C.” Practice Location

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