Provider Demographics
NPI:1124187117
Name:MALMSTROM, LEE DANIEL (DC)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:DANIEL
Last Name:MALMSTROM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-6004
Mailing Address - Country:US
Mailing Address - Phone:712-580-3294
Mailing Address - Fax:888-834-8986
Practice Address - Street 1:1025 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-6004
Practice Address - Country:US
Practice Address - Phone:712-580-3294
Practice Address - Fax:888-834-8986
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007136111N00000X
KS01-05084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor