MEDICARE: OUILLETTE CHIROPRACTIC PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301010364	MI

General Provider Information

NPI Number	:	1194187567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUILLETTE CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	8082 GRAND RIVER RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9341
Country	:	US
Telephone Number	:	810-295-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8082 GRAND RIVER RD
Second Line	:
City	:	BRIGHTON
State	:	MI
Zip	:	48114-9341
Country	:	US
Telephone Number	:	810-295-2200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. QUINN JOSEPH OUILLETTE
Credential	:	D.C.
Telephone Number	:	989-324-9778

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	12/03/2020

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