Provider Demographics
NPI:1992820732
Name:MALONE, KENNETH JOHN JR (DC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JOHN
Last Name:MALONE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1709
Mailing Address - Country:US
Mailing Address - Phone:631-998-4455
Mailing Address - Fax:631-998-4456
Practice Address - Street 1:204 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978-1709
Practice Address - Country:US
Practice Address - Phone:631-998-4455
Practice Address - Fax:631-998-4456
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0101301111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor