Mallory Miles Speth, DC
Individual provider Active NPI Chiropractor · Cobb, WI
NPI 1770116865 · NPPES record last updated Nov 8, 2023
Key facts
- NPI
- 1770116865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5482-12 (WI)
- Practice address
- 109 Division St
Cobb, WI 53526-8501 - Phone
- (608) 723-7723
- NPI assigned
- Feb 17, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200609000797 | WI | Practitioner - Chiropractic | 6901227446 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5482-12 | WI | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5482-12 | WI | Yes |
Addresses
Primary practice location
109 Division St
Cobb, WI 53526-8501
Mailing address
109 Division St
Cobb, WI 53526-8501
Phone (608) 292-9440
Other providers in Cobb, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.