Malzer Chiropractic LLC
Organization Active NPI Chiropractor · Lauderdale, MN
NPI 1972794675 · NPPES record last updated Mar 3, 2017
Key facts
- NPI
- 1972794675
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4449 (MN)
- Legal business name
- MALZER CHIROPRACTIC LLC
- Practice address
- 2443 Larpenteur Ave W
Lauderdale, MN 55113-5234 - Phone
- (651) 917-9800
- Fax
- (651) 917-9801
- NPI assigned
- Aug 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Brian Carl Malzer, D.C.
- Title
- Chief Manager
- Phone
- (651) 917-9800
Practitioners 5
-
Brian Carl Malzer, D.C.
-
Ruth A Blomster, LMT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050117000547 | MN | Part B Supplier - Clinic/Group Practice | 3870542863 |
Receives reassigned benefits from 1 practitioner Practice locations: Lauderdale, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4449 | MN | Yes |
| Chiropractor |
111N00000X | 6168 | MN |
Addresses
Primary practice location
2443 Larpenteur Ave W
Lauderdale, MN 55113-5234
Mailing address
2443 Larpenteur Ave W
Lauderdale, MN 55113-5234
Phone (651) 917-9800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 866439100 | Medicaid | MN | |
| 1134181928 | Other | NPI | |
| 1821454133 | Other | MN | NPI INDIVIDUAL |
Other names
- Lauderdale Wellness Center
Other providers in Lauderdale, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.