Provider Demographics
NPI:1578590329
Name:KUKUCSKA LE, LAURA (DC, CACCP, CCSP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KUKUCSKA LE
Suffix:
Gender:F
Credentials:DC, CACCP, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4335 WINDSOR CENTRE TRL
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-539-7500
Mailing Address - Fax:972-539-7550
Practice Address - Street 1:4401 LONG PRAIRIE RD
Practice Address - Street 2:STE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2007
Practice Address - Country:US
Practice Address - Phone:972-539-7500
Practice Address - Fax:972-539-7550
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1578590329OtherNPI
TX8CB857OtherBCBS
TXTXB03353Medicare PIN
TX8CB857OtherBCBS