Provider Demographics
NPI:1770792186
Name:MALOOF CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:MALOOF CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALOOF
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BCAO
Authorized Official - Phone:770-923-1111
Mailing Address - Street 1:1235 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3003
Mailing Address - Country:US
Mailing Address - Phone:770-923-1111
Mailing Address - Fax:770-923-0117
Practice Address - Street 1:1235 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3003
Practice Address - Country:US
Practice Address - Phone:770-923-1111
Practice Address - Fax:770-923-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006838261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1205914207OtherNPI NUMBER
GAGRP5117OtherMEDICARE GROUP NUMBER
GA1205914207OtherNPI NUMBER
GAU85999Medicare UPIN
GA35ZCHHJMedicare ID - Type Unspecified
GAP00086471Medicare ID - Type UnspecifiedRAILROAD MEDICARE