Healthcare Provider Details

I. General information

NPI: 1639357627
Provider Name (Legal Business Name): NICHOLE APRIL RAKOW D.C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICHOLE APRIL VERNIER D.C.

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 ABERDEEN ST NE SUITE 100
BLAINE MN
55449-5174
US

IV. Provider business mailing address

12203 ABERDEEN ST NE SUITE 100
BLAINE MN
55449-5174
US

V. Phone/Fax

Practice location:
  • Phone: 763-785-4120
  • Fax: 763-785-4172
Mailing address:
  • Phone: 763-785-4120
  • Fax: 763-785-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX384247956915
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: