Emily Samantha Mallon, D.C.
Individual provider Active NPI Chiropractor · Bruceton Mills, WV
NPI 1154376291 · NPPES record last updated Aug 1, 2024
Key facts
- NPI
- 1154376291
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 895 (WV)
- Practice address
- 15630 N Preston Hwy
Bruceton Mills, WV 26525-7036 - Phone
- (517) 285-0417
- NPI assigned
- May 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advantage Health and Wellness, PLLC
Practice addresses (Care Compare)
699 Burroughs St
Morgantown, WV 26505-3361
Phone (304) 225-9355
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090708000309 | WV | Practitioner - Chiropractic | 4880606573 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038-010671 | IL | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Healing Hands Chiropractic, PLLC | Current |
Accepting new patients | |
| Bruceton Wellness Center PLLC | Chiropractor | Current |
Accepting new patients |
| Advantage Health & Wellness, PLLC | Chiropractor | Current |
Accepting new patients |
| Every Bodys Chiropractic PLLC | Chiropractor | Past | Accepting new patients |
| Advantage Health & Wellness PLLC | Chiropractor | Past | Accepting new patients |
Locations
15630 N Preston Hwy
Bruceton Mls, WV 26525
Phone (304) 379-7000
809 Medical Dr
Glenville, WV 26351
Phone (304) 462-7351
699 Burroughs St
Morgantown, WV 26505
Phone (304) 225-9355
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 038-010671 | IL | |
| Chiropractor | 111N00000X | 895 | WV | Yes |
Addresses
Primary practice location
15630 N Preston Hwy
Bruceton Mills, WV 26525-7036
Mailing address
36 Founders Way
Morgantown, WV 26508-1102
Phone (517) 285-0417
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810015448 | Medicaid | WV |
Other providers in Bruceton Mills, WV
- Nicole Lewis
- Steven Christopher Lint
- Little Minds Speech Therapy LLC
- Sandrela Magnuson
- James Daniel Mallett
- Margie Uryasz LLC
- Lorisa Lynne Markle
- Patricia Martin
- Julie Annette Martinez-Aguilar
- Sheri Lynn McGuire
All providers in Bruceton Mills, WV · Chiropractor in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.