Provider Demographics
NPI:1417330168
Name:ST. LAURENT, ADAM GERARD (DC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:GERARD
Last Name:ST. LAURENT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 WYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7945
Mailing Address - Country:US
Mailing Address - Phone:207-608-0813
Mailing Address - Fax:
Practice Address - Street 1:7532 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5110
Practice Address - Country:US
Practice Address - Phone:407-363-0052
Practice Address - Fax:407-363-0566
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor