Provider Demographics
NPI:1366594673
Name:MUDRAK, LAURA MARIE (DC LAC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MARIE
Last Name:MUDRAK
Suffix:
Gender:F
Credentials:DC LAC
Other - Prefix:
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Mailing Address - Street 1:821 RAYMOND AVE
Mailing Address - Street 2:#110
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114
Mailing Address - Country:US
Mailing Address - Phone:651-690-5543
Mailing Address - Fax:651-251-1183
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:#110
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114
Practice Address - Country:US
Practice Address - Phone:651-690-5543
Practice Address - Fax:651-251-1183
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN3109111N00000X
MN1234171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist