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General NPI Number Information
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NPI Number | 1801087903
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Entity Type | Organization
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Legal Business Name | COULSON CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 13800 83RD WAY N SUITE 108
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7016
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Country | US
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Telephone | 763-494-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 13800 83RD WAY N SUITE 108
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City | MAPLE GROVE
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State | MN
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Zip | 55369-7016
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Country | US
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Telephone | 763-494-0828
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ANDREW ROBERT COULSON
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Credential | D.C.
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Telephone | 763-494-0828
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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 | 4988
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License Number State | MN
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