MEDICARE: DR. CHETT LEGRAND MALLETT 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
1	111N00000X	Chiropractor	27812	CA

General Provider Information

NPI Number	:	1780777003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHETT LEGRAND MALLETT D.C.

Provider Business Mailing Address
First Line	:	3535 CAHUENGA BLVD W STE 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1359
Country	:	US
Telephone Number	:	323-968-3535
Fax Number	:	323-435-5138

Provider Business Practice Location Address
First Line	:	3535 CAHUENGA BLVD W STE 206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-1359
Country	:	US
Telephone Number	:	323-968-3535
Fax Number	:	323-435-5138

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	07/28/2022

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