Provider Demographics
NPI:1174786800
Name:PERREAULT, NICOLE ROSANNA (DC)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ROSANNA
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:ROSANNA
Other - Last Name:PERREAULT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069
Mailing Address - Country:US
Mailing Address - Phone:320-358-3441
Mailing Address - Fax:320-358-3624
Practice Address - Street 1:263 W 4TH STREET
Practice Address - Street 2:
Practice Address - City:RUSH CITY
Practice Address - State:MN
Practice Address - Zip Code:55069
Practice Address - Country:US
Practice Address - Phone:320-358-3441
Practice Address - Fax:320-358-3624
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN104388171100000X
MN5751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist