Healthcare Provider Details

I. General information

NPI: 1912907304
Provider Name (Legal Business Name): STEVEN RAY LAUT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 N MAPLE GROVE AVE
HUDSON MI
49247-1148
US

IV. Provider business mailing address

PO BOX 31 794 N. MAPLE GR. AVE.
HUDSON MI
49247-0031
US

V. Phone/Fax

Practice location:
  • Phone: 517-448-8515
  • Fax: 517-448-3044
Mailing address:
  • Phone: 517-448-8515
  • Fax: 517-448-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberL173693
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: