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General NPI Number Information
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NPI Number | 1063913671
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Entity Type | Organization
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Legal Business Name | PRONEURO HEALTH LLC
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Dates
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Enumeration Date | 02/28/2018
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 2601 SAGEBRUSH DR STE 104
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2744
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Country | US
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Telephone | 972-479-5179
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 SAGEBRUSH DR STE 104
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City | FLOWER MOUND
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State | TX
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Zip | 75028-2744
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Country | US
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Telephone | 972-479-5179
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUBEN ST LAURENT
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Credential | DC, DACNB
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Telephone | 972-479-5179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NN0400X
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Taxonomy Name | Neurology Chiropractor
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License Number | 10667
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License Number State | TX
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