Provider Demographics
NPI:1700851441
Name:MALOCHLEB, LORI R (DC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:R
Last Name:MALOCHLEB
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI202239538OtherTAX ID
MI950G311710OtherBCBSM
MI01003171OtherHEALTH PLUS
MI4633192Medicaid
MI01003171OtherHEALTH PLUS
MI950G311710OtherBCBSM
MI0P15640Medicare ID - Type UnspecifiedGROUP ID