Physician Compare National (NPI:1366594673)

HEALTHCARE PROVIDER: LAURA MARIE MUDRAK DC LAC

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1366594673
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0547445819
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110502000176
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MUDRAK
	Individual professional last name
Provider First Name	LAURA
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	NORTHWESTERN COLLEGE OF CHIROPRACTIC
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	CHIROPRACTIC
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	821 RAYMOND AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 110
	Group Practice or individual's line 2 address
City	SAINT PAUL
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	551141538
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M