Provider Demographics
NPI:1164644514
Name:GERARD, MARIE ROSE JOSEE (DC)
Entity Type:Individual
Prefix:
First Name:MARIE ROSE
Middle Name:JOSEE
Last Name:GERARD
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 1:25557 E COMFORT DR
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9466
Mailing Address - Country:US
Mailing Address - Phone:651-464-0800
Mailing Address - Fax:
Practice Address - Street 1:255 HIGHWAY 97 UNIT 2A
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-2687
Practice Address - Country:US
Practice Address - Phone:651-464-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4270111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor