Provider Demographics
NPI:1346653268
Name:LAUDUN, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LAUDUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56634 BOSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8625
Mailing Address - Country:US
Mailing Address - Phone:985-641-2222
Mailing Address - Fax:985-649-3864
Practice Address - Street 1:2424 WILLIAMS BLVD
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-5763
Practice Address - Country:US
Practice Address - Phone:504-464-0719
Practice Address - Fax:504-464-0721
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1702111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor