Provider Demographics
NPI:1346389624
Name:WERNER, LAURA JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JOAN
Last Name:WERNER
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 1:1976 HACKAMORE LN
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-6804
Mailing Address - Country:US
Mailing Address - Phone:775-265-4657
Mailing Address - Fax:
Practice Address - Street 1:1976 HACKAMORE LN
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-6804
Practice Address - Country:US
Practice Address - Phone:775-265-4657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV36454Medicare UPIN