Provider Demographics
NPI:1639595598
Name:CROTEAU, TAWNEE (D C)
Entity Type:Individual
Prefix:
First Name:TAWNEE
Middle Name:
Last Name:CROTEAU
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIWABIK
Mailing Address - State:MN
Mailing Address - Zip Code:55708-3061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 5TH ST NE # 1
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-2732
Practice Address - Country:US
Practice Address - Phone:320-631-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor