Provider Demographics
NPI:1871881011
Name:PALLESEN, LAURA (DC)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PALLESEN
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 1:3065 CLAIREMONT DR STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6895
Mailing Address - Country:US
Mailing Address - Phone:763-300-7843
Mailing Address - Fax:
Practice Address - Street 1:3065 CLAIREMONT DR STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6895
Practice Address - Country:US
Practice Address - Phone:763-300-7843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32554111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor