MEDICARE: MALLEN CHIROPRACTIC INC.

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
1	111N00000X	Chiropractor	CH7184	FL

General Provider Information

NPI Number	:	1528365806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALLEN CHIROPRACTIC INC.

Provider Business Mailing Address
First Line	:	7420 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4812
Country	:	US
Telephone Number	:	561-588-7780
Fax Number	:	561-588-9655

Provider Business Practice Location Address
First Line	:	7420 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-4812
Country	:	US
Telephone Number	:	561-588-7780
Fax Number	:	561-588-9655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD JOHN MALLEN
Credential	:	D.C.
Telephone Number	:	561-588-7780

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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