Provider Demographics
NPI:1467592923
Name:MALM, CLIFTON LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CLIFTON
Middle Name:LEE
Last Name:MALM
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 1:2516 ELMWAY
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-9629
Mailing Address - Country:US
Mailing Address - Phone:150-942-2470
Mailing Address - Fax:
Practice Address - Street 1:2516 ELMWAY
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-9629
Practice Address - Country:US
Practice Address - Phone:150-942-2470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2566305Medicaid
WAG0003000948Medicare ID - Type Unspecified