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General NPI Number Information
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NPI Number | 1922541044
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Entity Type | Organization
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Legal Business Name | PERREAULT CHIROPRACTIC AND ACUPUNCTURE SERVICE CORPORATION
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 01/11/2017
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Provider Practice Location Address
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Address Line | 6361 MAIN ST
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City | NORTH BRANCH
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State | MN
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Zip | 55056-6693
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Country | US
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Telephone | 651-674-4833
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Fax | 651-674-5847
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Provider Business Mailing Address
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Address Line | 6361 MAIN ST PO BOX 782
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City | NORTH BRANCH
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State | MN
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Zip | 55056-6693
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Country | US
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Telephone | 651-674-4833
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Fax | 651-674-5847
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Authorized Official
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Title or Position | OWNER
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Name | JULIE PERREAULT
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Credential | D.C.
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Telephone | 651-674-4833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4230
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License Number State | MN
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