Healthcare Provider Details

I. General information

NPI: 1518051796
Provider Name (Legal Business Name): LANCE ERIC MALMSTROM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SW TOPEKA BLVD
TOPEKA KS
66612-1851
US

IV. Provider business mailing address

1520 SW TOPEKA BLVD
TOPEKA KS
66612-1851
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-1131
  • Fax: 785-235-3771
Mailing address:
  • Phone: 785-235-1131
  • Fax: 636-944-0514

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:
Title or Position:
Credential:
Phone: