Provider Demographics
NPI:1285287839
Name:JAMES J MALAVOLTI DC LLC
Entity type:Organization
Organization Name:JAMES J MALAVOLTI DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALAVOLTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-693-7887
Mailing Address - Street 1:7918 N HALE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2048
Mailing Address - Country:US
Mailing Address - Phone:309-693-7887
Mailing Address - Fax:
Practice Address - Street 1:7918 N HALE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2048
Practice Address - Country:US
Practice Address - Phone:309-693-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty