MEDICARE: PERREAULT CHIROPRACTIC AND ACUPUNCTURE SERVICE CORPORATION

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	4230	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	1699711614	OTHER		INDIVIDUAL NPI

General Provider Information

NPI Number	:	1922541044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERREAULT CHIROPRACTIC AND ACUPUNCTURE SERVICE CORPORATION

Provider Business Mailing Address
First Line	:	6361 MAIN ST
Second Line	:	PO BOX 782
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6693
Country	:	US
Telephone Number	:	651-674-4833
Fax Number	:	651-674-5847

Provider Business Practice Location Address
First Line	:	6361 MAIN ST
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6693
Country	:	US
Telephone Number	:	651-674-4833
Fax Number	:	651-674-5847

Authorized Official
Title or Position	:	OWNER
Name	:	JULIE PERREAULT
Credential	:	D.C.
Telephone Number	:	651-674-4833

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	01/11/2017

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