Provider Demographics
NPI:1336270255
Name:MALMSTROM, LEAH MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:MALMSTROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:MARIE
Other - Last Name:THOMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
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:844-832-6407
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:844-832-6407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor