Provider Demographics
NPI:1699711614
Name:PERREAULT, JULIE A (DC)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:PERREAULT
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 1:6361 MAIN ST
Mailing Address - Street 2:PO BOX 782
Mailing Address - City:NO BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056
Mailing Address - Country:US
Mailing Address - Phone:651-674-4833
Mailing Address - Fax:651-674-5847
Practice Address - Street 1:6361 MAIN ST
Practice Address - Street 2:
Practice Address - City:NO BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056
Practice Address - Country:US
Practice Address - Phone:651-674-4833
Practice Address - Fax:651-674-5847
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4230111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN627705OtherACN CHIRO CARE
MN065880400Medicaid
MN142T1PEOtherBCBSM
MN065880400Medicaid
MN350002601Medicare ID - Type Unspecified