Provider Demographics
NPI:1730204546
Name:MIX, LAURA MICHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:MIX
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:807 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3807
Mailing Address - Country:US
Mailing Address - Phone:512-321-9200
Mailing Address - Fax:512-321-9201
Practice Address - Street 1:807 MAIN ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3807
Practice Address - Country:US
Practice Address - Phone:512-321-9200
Practice Address - Fax:512-321-9201
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor