Provider Demographics
NPI:1992346043
Name:PERRAULT, RAYMOND E
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:E
Last Name:PERRAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 FOSTER WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3156
Mailing Address - Country:US
Mailing Address - Phone:916-291-6052
Mailing Address - Fax:
Practice Address - Street 1:4535 FOSTER WAY
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3156
Practice Address - Country:US
Practice Address - Phone:916-291-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor