Provider Demographics
NPI:1548314156
Name:AUSTRAGER, LAURIE MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:MICHELLE
Last Name:AUSTRAGER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 TEMPLE ST
Mailing Address - Street 2:E508
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2405
Mailing Address - Country:US
Mailing Address - Phone:508-626-0080
Mailing Address - Fax:
Practice Address - Street 1:235 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7592
Practice Address - Country:US
Practice Address - Phone:508-620-1585
Practice Address - Fax:508-620-0436
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45292Medicare ID - Type Unspecified
U78595Medicare UPIN