Provider Demographics
NPI:1265620751
Name:NICOLE M. LAUER CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:NICOLE M. LAUER CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-772-8723
Mailing Address - Street 1:2600 S MERIDIAN
Mailing Address - Street 2:APT 1412
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1556
Mailing Address - Country:US
Mailing Address - Phone:763-772-8723
Mailing Address - Fax:253-473-2484
Practice Address - Street 1:2600 S MERIDIAN
Practice Address - Street 2:APT 1412
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1556
Practice Address - Country:US
Practice Address - Phone:763-772-8723
Practice Address - Fax:253-473-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4978261Q00000X
WACH60023270261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center