Provider Demographics
NPI:1730111303
Name:LORI MALOCHLEB DC PC
Entity Type:Organization
Organization Name:LORI MALOCHLEB DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:R
Authorized Official - Last Name:MALOCHLEB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-652-2577
Mailing Address - Street 1:143 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKENMUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48734-1304
Mailing Address - Country:US
Mailing Address - Phone:989-652-2577
Mailing Address - Fax:989-652-4776
Practice Address - Street 1:143 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:FRANKENMUTH
Practice Address - State:MI
Practice Address - Zip Code:48734-1304
Practice Address - Country:US
Practice Address - Phone:989-652-2577
Practice Address - Fax:989-652-4776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILM006154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4633192Medicaid
MI01003171OtherHEALTH PLUS
MI0G311710OtherBLUE CROSS BLUE SHIELD
MI0G311710OtherBLUE CROSS BLUE SHIELD
MI0P15640Medicare ID - Type Unspecified