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General NPI Number Information
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NPI Number | 1205894870
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Entity Type | Individual
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Provider Name | DR. CARRIE LYNN COLLYARD-GLINSEK
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 19242 EVANS ST NW
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City | ELK RIVER
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State | MN
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Zip | 55330-1076
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Country | US
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Telephone | 763-274-0377
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Fax |
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Provider Business Mailing Address
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Address Line | 11044 255TH AVE NW
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4578
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Country | US
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Telephone | 763-856-2828
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Fax | 763-633-0366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC4090
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License Number State | MN
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