MEDICARE: MICHAEL MALLOY 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	12960	TX

General Provider Information

NPI Number	:	1881078806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MALLOY D.C.

Provider Business Mailing Address
First Line	:	6800 HARRIS PKWY STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4262
Country	:	US
Telephone Number	:	817-346-1111
Fax Number	:	855-715-0886

Provider Business Practice Location Address
First Line	:	6800 HARRIS PKWY STE 400
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4262
Country	:	US
Telephone Number	:	817-229-5750
Fax Number	:

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

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	05/29/2024

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