MEDICARE: DR. JONATHAN MALLEY 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	B01832	NV

General Provider Information

NPI Number	:	1902429384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MALLEY DC

Provider Business Mailing Address
First Line	:	9350 DOUBLE R BLVD APT 611
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89521-3806
Country	:	US
Telephone Number	:	774-272-2382
Fax Number	:

Provider Business Practice Location Address
First Line	:	894 SOUTHWOOD BLVD
Second Line	:
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451-9435
Country	:	US
Telephone Number	:	775-831-5544
Fax Number	:

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

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	05/20/2020

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