Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 173695-1202 | UT |
NPI | 1770612566 |
---|---|
Provider Name | Dr. Randall F. Malin |
First Address | Salt Lake City, UT 84107-3885 |
Second Address | Salt Lake City, UT 84107-3885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2007 |
Last Update Date | 08/07/2007 |