Provider Demographics
NPI:1629250972
Name:LAURES, CHRISTOPHER VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:VINCENT
Last Name:LAURES
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 1:711 SIOUX POINT ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-0000
Mailing Address - Country:US
Mailing Address - Phone:605-232-1711
Mailing Address - Fax:605-232-2040
Practice Address - Street 1:3403 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5109
Practice Address - Country:US
Practice Address - Phone:712-255-9909
Practice Address - Fax:712-252-4730
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-01679111N00000X
IA007040111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSM700000Medicare PIN