Healthcare Provider Details

I. General information

NPI: 1730111303
Provider Name (Legal Business Name): LORI MALOCHLEB DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 W GENESEE ST
FRANKENMUTH MI
48734-1304
US

IV. Provider business mailing address

143 W GENESEE ST
FRANKENMUTH MI
48734-1304
US

V. Phone/Fax

Practice location:
  • Phone: 989-652-2577
  • Fax: 989-652-4776
Mailing address:
  • Phone: 989-652-2577
  • Fax: 989-652-4776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberLM006154
License Number StateMI

VIII. Authorized Official

Name: DR. LORI R MALOCHLEB
Title or Position: OWNER
Credential: DC
Phone: 989-652-2577