Provider Demographics
NPI:1093170136
Name:PERREAULT, KELSEY MARGARET (DC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARGARET
Last Name:PERREAULT
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:MARGARET
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1891 E HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3278
Mailing Address - Country:US
Mailing Address - Phone:218-326-0046
Mailing Address - Fax:
Practice Address - Street 1:1891 E HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3278
Practice Address - Country:US
Practice Address - Phone:218-326-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor