Provider Demographics
NPI:1639357627
Name:RAKOW, NICHOLE APRIL (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:APRIL
Last Name:RAKOW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:NICHOLE
Other - Middle Name:APRIL
Other - Last Name:VERNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:12203 ABERDEEN ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5174
Mailing Address - Country:US
Mailing Address - Phone:763-785-4120
Mailing Address - Fax:763-785-4172
Practice Address - Street 1:12203 ABERDEEN ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5174
Practice Address - Country:US
Practice Address - Phone:763-785-4120
Practice Address - Fax:763-785-4172
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNX384247956915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38182300Medicaid
WI$$$$$$$$$005OtherBC/BS
WI38182300Medicaid