Provider Demographics
NPI:1235100710
Name:WONDRA, LAURI L (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:L
Last Name:WONDRA
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 1:724 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:FORT MADISON
Mailing Address - State:IA
Mailing Address - Zip Code:52627-2927
Mailing Address - Country:US
Mailing Address - Phone:319-372-7898
Mailing Address - Fax:319-372-5232
Practice Address - Street 1:724 AVENUE G
Practice Address - Street 2:
Practice Address - City:FORT MADISON
Practice Address - State:IA
Practice Address - Zip Code:52627-2927
Practice Address - Country:US
Practice Address - Phone:319-372-7898
Practice Address - Fax:319-372-5232
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06523111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA525812OtherIOWA HEALTH SOLUTIONS
IA0444232Medicaid
IA19790OtherWELLMARK BCBS
IA0444232Medicaid
U99314Medicare UPIN