MEDICARE: DR. JOANNE LORRAINE THERRIAULT D.C

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	8024	AZ

General Provider Information

NPI Number	:	1548208739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE LORRAINE THERRIAULT D.C

Provider Business Mailing Address
First Line	:	3733 KARICIO LN
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-6829
Country	:	US
Telephone Number	:	928-442-0202
Fax Number	:	928-776-8858

Provider Business Practice Location Address
First Line	:	3733 KARICIO LN
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86303-6829
Country	:	US
Telephone Number	:	928-442-0202
Fax Number	:	928-776-8858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/17/2008

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