Provider Demographics
NPI:1861819526
Name:PRICE-BOURISAW, LAURA (DC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:PRICE-BOURISAW
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 1:8 WARSEN AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-4811
Mailing Address - Country:US
Mailing Address - Phone:314-922-0586
Mailing Address - Fax:
Practice Address - Street 1:8 WARSEN AVE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-4811
Practice Address - Country:US
Practice Address - Phone:314-922-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014006004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor