Provider Demographics
NPI:1871869826
Name:MINDMENDERS CLINIC
Entity type:Organization
Organization Name:MINDMENDERS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ST. LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-479-5179
Mailing Address - Street 1:2670 FIREWHEEL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-4601
Mailing Address - Country:US
Mailing Address - Phone:972-479-5179
Mailing Address - Fax:817-394-2342
Practice Address - Street 1:2670 FIREWHEEL DR
Practice Address - Street 2:SUITE A
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-4601
Practice Address - Country:US
Practice Address - Phone:972-479-5179
Practice Address - Fax:817-394-2342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10667111N00000X, 111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Multi-Specialty