MEDICARE: ADAM MALICK DC

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	13661	FL

General Provider Information

NPI Number	:	1770259046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM MALICK DC

Provider Business Mailing Address
First Line	:	687 TAMIAMI TRL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953-2903
Country	:	US
Telephone Number	:	941-743-9904
Fax Number	:

Provider Business Practice Location Address
First Line	:	687 TAMIAMI TRL
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33953-2903
Country	:	US
Telephone Number	:	941-743-9904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	08/18/2021

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