MEDICARE: DR. KARI JEAN BOUDREAU DOCTOR CHIROPRACTIC

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	3537	MN

General Provider Information

NPI Number	:	1609995216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI JEAN BOUDREAU DOCTOR CHIROPRACTIC

Provider Business Mailing Address
First Line	:	505 1ST AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-4541
Country	:	US
Telephone Number	:	612-424-6944
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 1ST AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-4541
Country	:	US
Telephone Number	:	612-424-6944
Fax Number	:

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	02/15/2012

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