MEDICARE: ADAM GERARD ST. LAURENT DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH11528	FL

General Provider Information

NPI Number	:	1417330168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM GERARD ST. LAURENT DC

Provider Business Mailing Address
First Line	:	1550 WYNGATE DR
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-7945
Country	:	US
Telephone Number	:	207-608-0813
Fax Number	:

Provider Business Practice Location Address
First Line	:	7532 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5110
Country	:	US
Telephone Number	:	407-363-0052
Fax Number	:	407-363-0566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	07/14/2015

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Directions to “ ADAM GERARD ST. LAURENT DC” Practice Location

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