Provider Demographics
NPI:1063584233
Name:REMILLARD, RACHEL M (DC)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:M
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1910
Mailing Address - Country:US
Mailing Address - Phone:508-795-0034
Mailing Address - Fax:
Practice Address - Street 1:136 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1910
Practice Address - Country:US
Practice Address - Phone:508-795-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2006111N00000X
CTCT1161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36661OtherBCBS
MAY36661OtherBCBS