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General NPI Number Information
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NPI Number | 1366608721
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Entity Type | Organization
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Legal Business Name | TRULIFE WELLNESS CHIROPRACTIC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 617 LONDONDERRY LN
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City | DENTON
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State | TX
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Zip | 76205-7792
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Country | US
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Telephone | 972-951-3885
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 E FRANKFORD RD APT 2406
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City | CARROLLTON
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State | TX
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Zip | 75007-5226
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Country | US
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Telephone |
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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 | D.C.
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Telephone | 972-951-3885
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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 | 10667
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License Number State | TX
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