Provider Demographics
NPI:1144714833
Name:MALLOY, JENNIFER L (DC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MALLOY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-9306
Mailing Address - Country:US
Mailing Address - Phone:908-810-9002
Mailing Address - Fax:908-810-9012
Practice Address - Street 1:418 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-9306
Practice Address - Country:US
Practice Address - Phone:908-810-9002
Practice Address - Fax:908-810-9012
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00748300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor