MEDICARE: DR. DAVID WILLIAM LAUDON D.C.

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	4587	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	337K3LA	OTHER	MN	BLUECROSSBLUE SHEILDS MN

General Provider Information

NPI Number	:	1427180652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID WILLIAM LAUDON D.C.

Provider Business Mailing Address
First Line	:	717 ANDREWS AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-2146
Country	:	US
Telephone Number	:	952-484-5225
Fax Number	:

Provider Business Practice Location Address
First Line	:	717 ANDREWS AVE
Second Line	:
City	:	DETROIT LAKES
State	:	MN
Zip	:	56501-2146
Country	:	US
Telephone Number	:	952-484-5225
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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