Provider Demographics
NPI:1407131147
Name:MALUCCI, SHELLY R (DC)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:R
Last Name:MALUCCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 WOODSTOCK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2208
Mailing Address - Country:US
Mailing Address - Phone:678-896-2783
Mailing Address - Fax:888-218-5978
Practice Address - Street 1:925 WOODSTOCK RD STE 102
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2208
Practice Address - Country:US
Practice Address - Phone:770-626-0326
Practice Address - Fax:888-218-5978
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor