MEDICARE: DR. GREGG MICHAEL POQUETTE 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	2402	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	51364PO	OTHER	MN	BLUE CROSS

General Provider Information

NPI Number	:	1679657001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGG MICHAEL POQUETTE D.C.

Provider Business Mailing Address
First Line	:	4660 SLATER RD
Second Line	:	SUITE 140
City	:	EAGAN
State	:	MN
Zip	:	55122-4047
Country	:	US
Telephone Number	:	651-452-3900
Fax Number	:	651-452-3901

Provider Business Practice Location Address
First Line	:	4660 SLATER RD
Second Line	:	SUITE 140
City	:	EAGAN
State	:	MN
Zip	:	55122-4047
Country	:	US
Telephone Number	:	651-452-3900
Fax Number	:	651-452-3901

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/12/2011

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