Provider Demographics
NPI:1487747978
Name:MALAVOLTI, TOMMI SUSZAN (DC)
Entity type:Individual
Prefix:DR
First Name:TOMMI
Middle Name:SUSZAN
Last Name:MALAVOLTI
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 1:3644 PIPERS GAP
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333
Mailing Address - Country:US
Mailing Address - Phone:276-233-4735
Mailing Address - Fax:
Practice Address - Street 1:1070 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343
Practice Address - Country:US
Practice Address - Phone:276-730-9555
Practice Address - Fax:276-730-9557
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU99464Medicare UPIN
VA004312T58Medicare ID - Type Unspecified