MEDICARE: DR. ROGER E PERREAULT DC

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	1666	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1D067PE	OTHER	BCBSM
2	230668	OTHER	ACN CHIRO CARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912942178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER E PERREAULT DC

Provider Business Mailing Address
First Line	:	263 W 4TH ST
Second Line	:	PO BOX 86
City	:	RUSH CITY
State	:	MN
Zip	:	55069
Country	:	US
Telephone Number	:	320-358-3441
Fax Number	:	320-358-3624

Provider Business Practice Location Address
First Line	:	263 W 4TH ST
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069
Country	:	US
Telephone Number	:	320-358-3441
Fax Number	:	320-358-3624

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	04/28/2017

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