Provider Demographics
NPI:1144363920
Name:LOUISIANA, MAUDIE RAE (DC)
Entity type:Individual
Prefix:DR
First Name:MAUDIE
Middle Name:RAE
Last Name:LOUISIANA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:103 CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2957
Mailing Address - Country:US
Mailing Address - Phone:763-682-0611
Mailing Address - Fax:763-682-0788
Practice Address - Street 1:103 CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2957
Practice Address - Country:US
Practice Address - Phone:763-682-0611
Practice Address - Fax:763-682-0788
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNDC 3992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN064G0LOOtherBLUE CROSS BLUE SHIELD
MNU82160Medicare UPIN