Healthcare Provider Details

I. General information

NPI: 1134181928
Provider Name (Legal Business Name): BRIAN CARL MALZER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2443 LARPENTEUR AVE W
LAUDERDALE MN
55113-5200
US

IV. Provider business mailing address

1824 WALNUT ST
LAUDERDALE MN
55113-5245
US

V. Phone/Fax

Practice location:
  • Phone: 651-917-9800
  • Fax: 651-917-9801
Mailing address:
  • Phone: 651-647-6972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4449
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: