Provider Demographics
NPI:1134181928
Name:MALZER, BRIAN CARL (DC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CARL
Last Name:MALZER
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 1:1824 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5245
Mailing Address - Country:US
Mailing Address - Phone:651-647-6972
Mailing Address - Fax:
Practice Address - Street 1:2443 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:LAUDERDALE
Practice Address - State:MN
Practice Address - Zip Code:55113-5200
Practice Address - Country:US
Practice Address - Phone:651-917-9800
Practice Address - Fax:651-917-9801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4449111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN540T6MAOtherIND. BCBS PROVDER #
MN540T6MAOtherIND. BCBS PROVDER #