Provider Demographics
NPI:1164716668
Name:MCBROOM, LAURA (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MCBROOM
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 1:116 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:WANAMINGO
Mailing Address - State:MN
Mailing Address - Zip Code:55983-1466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:116 1ST AVE
Practice Address - Street 2:
Practice Address - City:WANAMINGO
Practice Address - State:MN
Practice Address - Zip Code:55983-1466
Practice Address - Country:US
Practice Address - Phone:507-273-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5547111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor