Provider Demographics
NPI:1033829726
Name:BARNUM, LAURA MARIE (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:BARNUM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 KOOPMANS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1609
Mailing Address - Country:US
Mailing Address - Phone:949-350-5287
Mailing Address - Fax:
Practice Address - Street 1:9000 SOQUEL AVE STE 101A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2097
Practice Address - Country:US
Practice Address - Phone:831-204-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor