MEDICARE: DR. ANDREW KOLLAR III D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1220	MN

General Provider Information

NPI Number	:	1679579627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW KOLLAR III D.C.

Provider Business Mailing Address
First Line	:	939 OLD HIGHWAY 8 NW
Second Line	:	STE 200
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2787
Country	:	US
Telephone Number	:	651-636-4120
Fax Number	:	651-636-9992

Provider Business Practice Location Address
First Line	:	939 OLD HIGHWAY 8 NW
Second Line	:	STE 200
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-2787
Country	:	US
Telephone Number	:	651-636-4120
Fax Number	:	651-636-9992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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