Provider Demographics
NPI:1487988077
Name:AGGEN, LAURA NICOLE (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:NICOLE
Last Name:AGGEN
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 1:6125 N SUNSHINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8688
Mailing Address - Country:US
Mailing Address - Phone:208-772-0802
Mailing Address - Fax:208-762-3531
Practice Address - Street 1:6125 N SUNSHINE ST STE A
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-8688
Practice Address - Country:US
Practice Address - Phone:208-772-0802
Practice Address - Fax:208-762-3531
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1357111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor