Provider Demographics
NPI:1487712303
Name:LACROIX, MICHELLE JOANNE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JOANNE
Last Name:LACROIX
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CENTRAL AVE N
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5211
Mailing Address - Country:US
Mailing Address - Phone:507-331-2930
Mailing Address - Fax:507-334-9079
Practice Address - Street 1:122 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5211
Practice Address - Country:US
Practice Address - Phone:507-331-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP49620OtherHEALTHPARTNERS
MN70G40ACOtherBLUE CROSS BLUE SHIELD