Provider Demographics
NPI:1053533448
Name:MALVERNE CHIROPRACTIC OFFICE, PLLC
Entity type:Organization
Organization Name:MALVERNE CHIROPRACTIC OFFICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-599-3999
Mailing Address - Street 1:4 WEBER AVENUE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565
Mailing Address - Country:US
Mailing Address - Phone:516-599-3999
Mailing Address - Fax:516-887-8106
Practice Address - Street 1:4 WEBER AVENUE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565
Practice Address - Country:US
Practice Address - Phone:516-599-3999
Practice Address - Fax:516-887-8106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXFWPX1OtherMEDICARE PTAN#
NYXFWPX1OtherMEDICARE PTAN#
NYX5Q891Medicare ID - Type Unspecified