Provider Demographics
NPI:1518051796
Name:MALMSTROM, LANCE ERIC (DC)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
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 1:1520 SW TOPEKA BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1851
Mailing Address - Country:US
Mailing Address - Phone:785-235-1131
Mailing Address - Fax:636-944-0514
Practice Address - Street 1:1520 SW TOPEKA BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66612-1851
Practice Address - Country:US
Practice Address - Phone:785-235-1131
Practice Address - Fax:785-235-3771
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03498111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS017503OtherBCBS
KS100095140AMedicaid
KS350011260OtherRR MEDICARE
KST77092Medicare UPIN
KS017503Medicare ID - Type Unspecified