Provider Demographics
NPI:1730448077
Name:MALLEY, KATIE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LYNN
Last Name:MALLEY
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 1:2480 CYPRESS POND RD
Mailing Address - Street 2:APT 412
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1537
Mailing Address - Country:US
Mailing Address - Phone:774-272-1151
Mailing Address - Fax:
Practice Address - Street 1:2480 CYPRESS POND RD
Practice Address - Street 2:APT 412
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1537
Practice Address - Country:US
Practice Address - Phone:774-272-1151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10627111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor