Healthcare Provider Details

I. General information

NPI: 1356434229
Provider Name (Legal Business Name): LANCE E MALMSTROM DC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SW TOPEKA AVE.
TOPEKA KS
66612
US

IV. Provider business mailing address

1520 SW TOPEKA AVE.
TOPEKA KS
66612
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-1131
  • Fax: 785-235-3771
Mailing address:
  • Phone: 785-235-1131
  • Fax: 785-235-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number01-03498
License Number StateKS

VIII. Authorized Official

Name: DR. LANCE ERIC MALMSTROM
Title or Position: PRESIDENT
Credential: DC
Phone: 785-235-1131