Provider Demographics
NPI:1295581601
Name:DECOCK, MIRIAM A (CHNP, PT)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:A
Last Name:DECOCK
Suffix:
Gender:F
Credentials:CHNP, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30427 610TH AVE
Mailing Address - Street 2:
Mailing Address - City:WADENA
Mailing Address - State:MN
Mailing Address - Zip Code:56482-4426
Mailing Address - Country:US
Mailing Address - Phone:218-639-6742
Mailing Address - Fax:
Practice Address - Street 1:30427 610TH AVE
Practice Address - Street 2:
Practice Address - City:WADENA
Practice Address - State:MN
Practice Address - Zip Code:56482-4426
Practice Address - Country:US
Practice Address - Phone:218-639-6742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach