Provider Demographics
NPI:1609995216
Name:BOUDREAU, KARI JEAN (DOCTOR CHIROPRACTIC)
Entity Type:Individual
Prefix:DR
First Name:KARI
Middle Name:JEAN
Last Name:BOUDREAU
Suffix:
Gender:F
Credentials:DOCTOR CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-4541
Mailing Address - Country:US
Mailing Address - Phone:612-424-6944
Mailing Address - Fax:
Practice Address - Street 1:505 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-4541
Practice Address - Country:US
Practice Address - Phone:612-424-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3537111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor