Provider Demographics
NPI:1669415113
Name:JOHNSRUD, LAURIE ANN (DC)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:JOHNSRUD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:KOSSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:1515 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1065
Mailing Address - Country:US
Mailing Address - Phone:218-739-3216
Mailing Address - Fax:218-739-2115
Practice Address - Street 1:1515 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1065
Practice Address - Country:US
Practice Address - Phone:218-739-3216
Practice Address - Fax:218-739-2115
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN040708001OtherPRIMEWEST
MN060G1KOOtherBLUE CROSS BLUE SHIELD
MN103100OtherHEALTHPARTNERS
MN108004100Medicaid
MNU92542Medicare UPIN
350003071Medicare ID - Type Unspecified
MN103100OtherHEALTHPARTNERS