Provider Demographics
NPI:1710226006
Name:POWELL-WILKINS, MALLORY LYNNETTE (DC)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:LYNNETTE
Last Name:POWELL-WILKINS
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 1:4509 DOWNING ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1101
Mailing Address - Country:US
Mailing Address - Phone:989-798-4225
Mailing Address - Fax:810-664-2380
Practice Address - Street 1:520 IMLAY CITY RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3178
Practice Address - Country:US
Practice Address - Phone:810-664-4741
Practice Address - Fax:810-664-2380
Is Sole Proprietor?:No
Enumeration Date:2013-02-06
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor