Provider Demographics
NPI:1265639462
Name:ST LAURENT, RUBEN (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:ST LAURENT
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 SAGEBRUSH DR STE 104
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2744
Mailing Address - Country:US
Mailing Address - Phone:972-479-5179
Mailing Address - Fax:
Practice Address - Street 1:2601 SAGEBRUSH DR
Practice Address - Street 2:SUITE 104
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2733
Practice Address - Country:US
Practice Address - Phone:972-479-5179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10667111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
No111N00000XChiropractic ProvidersChiropractor