Provider Demographics
NPI:1396841763
Name:SHOOK, LAURA LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:SHOOK
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 1:807 N WACO AVE STE 21
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3971
Mailing Address - Country:US
Mailing Address - Phone:316-267-6522
Mailing Address - Fax:
Practice Address - Street 1:807 N WACO AVE STE 21
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3971
Practice Address - Country:US
Practice Address - Phone:316-267-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS23855OtherBLUE CROSS BLUE SHIELD KS
KSKS3137OtherPREFERRED CHIROPRACTIC CA
KSKS3137OtherPREFERRED CHIROPRACTIC CA
KSU44342Medicare UPIN