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General NPI Number Information
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NPI Number | 1033306147
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Entity Type | Organization
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Legal Business Name | GREGG M POQUETTE B.S. D.C. P.A.
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 4660 SLATER RD SUITE 140
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City | EAGAN
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State | MN
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Zip | 55122-4047
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Country | US
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Telephone | 651-452-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 4660 SLATER RD SUITE 140
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City | EAGAN
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State | MN
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Zip | 55122-4047
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Country | US
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Telephone | 651-452-3900
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGG MICHAEL POQUETTE
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Credential | D.C.
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Telephone | 651-452-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 2402
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License Number State | MN
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