Individual provider Active NPI

Laura Marie Mudrak, DC LAC

  • Acupuncturist
  • Saint Paul, MN
National Provider Identifier
1366594673
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
1234 Issued in MN
Practice address
821 Raymond Ave
#110
St Paul, MN 55114
Phone
(651) 690-5543
Fax
(651) 251-1183
NPI assigned
Jan 17, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3109 MN
Acupuncturist 171100000X 1234 MN Primary

Addresses

Primary practice location

821 Raymond Ave
#110
St Paul, MN 55114

Mailing address

821 Raymond Ave
#110
St Paul, MN 55114
Phone (651) 690-5543

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110502000176 MN Practitioner - Chiropractic 0547445819 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1992
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

65 Cretin Ave N
Saint Paul, MN 55104-5701
Phone (651) 230-2802

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1234MNMDInternal Medicine Physician
3109MNMDCertified Registered Nurse Anesthetist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1366594673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE",
            "address_2": "#110",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55114",
            "telephone_number": "651-690-5543",
            "fax_number": "651-251-1183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "821 RAYMOND AVE",
            "address_2": "#110",
            "city": "ST PAUL",
            "state": "MN",
            "postal_code": "55114",
            "telephone_number": "651-690-5543",
            "fax_number": "651-251-1183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUDRAK",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DC LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3109",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MN",
            "license": "1234",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.