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General NPI Number Information
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NPI Number | 1497741185
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Entity Type | Individual
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Provider Name | CRAIG ALAN COUILLARD DC
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Gender | Male
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Dates
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Enumeration Date | 09/27/2005
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Last Update Date | 09/06/2011
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Provider Practice Location Address
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Address Line | 9202 202ND ST W SUITE 203
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City | LAKEVILLE
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State | MN
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Zip | 55044-7915
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Country | US
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Telephone | 952-469-8385
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Fax | 952-469-1713
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Provider Business Mailing Address
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Address Line | 9202 202ND ST W SUITE 203
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City | LAKEVILLE
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State | MN
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Zip | 55044-6855
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Country | US
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Telephone | 952-469-8385
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Fax | 952-469-1713
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 3955
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License Number State | MN
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