Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 01-03498 | KS |
NPI | 1518051796 |
---|---|
Provider Name | Dr. Lance Eric Malmstrom |
First Address | Topeka, KS 66612-1851 |
Second Address | Topeka, KS 66612-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 30/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017503 | BCBS (01) | KS |
100095140A | (05) | KS |
350011260 | RR MEDICARE (01) | KS |
T77092 | (02) | KS |