Provider Demographics
NPI:1588992614
Name:MALMSTROM, EMILY DIANE (DC)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:DIANE
Last Name:MALMSTROM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:DIANE
Other - Last Name:GARTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:14438 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3217
Mailing Address - Country:US
Mailing Address - Phone:402-210-2212
Mailing Address - Fax:402-408-9739
Practice Address - Street 1:14438 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3217
Practice Address - Country:US
Practice Address - Phone:402-651-1572
Practice Address - Fax:402-408-9739
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1590111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025947200Medicaid
NENA1764001Medicare PIN