Basic Information
Provider Information
NPI: 1508877085
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MORICE
FirstName: PIERRE
MiddleName: GILBERT
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3230 STALOCH PL
Address2:  
City: STILLWATER
State: MN
PostalCode: 550828390
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4080 W BROADWAY AVE
Address2: #300
City: ROBBINSDALE
State: MN
PostalCode: 554225604
CountryCode: US
TelephoneNumber: 7635330541
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
111N00000X4296MNY Chiropractic ProvidersChiropractor 

No ID Information.


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