Lauderdale Wellness Center | |
2443 Larpenteur Ave W, Lauderdale, MN 55113-5234 | |
(651) 917-9800 | |
(651) 917-9801 |
Full Name | Lauderdale Wellness Center |
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Type | Facility |
Speciality | Chiropractor |
Location | 2443 Larpenteur Ave W, Lauderdale, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1972794675 | NPI | - | NPPES |
866439100 | Medicaid | MN | |
1134181928 | Other | NPI | |
1821454133 | Other | MN | NPI INDIVIDUAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
111N00000X | Chiropractor | 4449 (Minnesota) | Primary |
111N00000X | Chiropractor | 6168 (Minnesota) | Secondary |
Provider Name | Brian C Malzer |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1134181928 PECOS PAC ID: 0749247302 Enrollment ID: I20041215000326 |
Provider Name | Mallory D Christopherson |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1821454133 PECOS PAC ID: 2264735166 Enrollment ID: I20160127001736 |
Mailing Address | Practice Location Address |
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Lauderdale Wellness Center 2443 Larpenteur Ave W, Lauderdale, MN 55113-5234 Ph: (651) 917-9800 | Lauderdale Wellness Center 2443 Larpenteur Ave W, Lauderdale, MN 55113-5234 Ph: (651) 917-9800 |
Mr. Brian Carl Malzer, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 2443 Larpenteur Ave W, Lauderdale, MN 55113 Phone: 651-917-9800 Fax: 651-917-9801 | |
Mallory Christopherson, D.C. Chiropractor Medicare: Accepting Medicare Assignments Practice Location: 2443 Larpenteur Ave W, Lauderdale, MN 55113 Phone: 651-917-9800 |