Healthcare Provider Details

I. General information

NPI: 1760757678
Provider Name (Legal Business Name): LAURA MOONEY DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 2ND ST NE STE C
BONDURANT IA
50035-1336
US

IV. Provider business mailing address

301 CENTER AVE S
MITCHELLVILLE IA
50169-9751
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-2700
  • Fax:
Mailing address:
  • Phone: 515-967-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007522
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: