Healthcare Provider Details

I. General information

NPI: 1578590329
Provider Name (Legal Business Name): LAURA KUKUCSKA LE DC, CACCP, CCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 LONG PRAIRIE RD STE 200
FLOWER MOUND TX
75028-2007
US

IV. Provider business mailing address

4335 WINDSOR CENTRE TRL SUITE 140
FLOWER MOUND TX
75028
US

V. Phone/Fax

Practice location:
  • Phone: 972-539-7500
  • Fax: 972-539-7550
Mailing address:
  • Phone: 972-539-7500
  • Fax: 972-539-7550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number9520
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: