MEDICARE: DR. LYLE CHARLES COLEMAN D.C., DIBCN

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	111NN0400X	Neurology Chiropractor	1245	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	138401300	OTHER		DOL PROVIDER NUMBER

General Provider Information

NPI Number	:	1083719561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE CHARLES COLEMAN D.C., DIBCN

Provider Business Mailing Address
First Line	:	207 W HOLLY ST
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-3959
Country	:	US
Telephone Number	:	507-451-1654
Fax Number	:	507-451-1655

Provider Business Practice Location Address
First Line	:	207 W HOLLY ST
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-3959
Country	:	US
Telephone Number	:	507-451-1654
Fax Number	:	507-451-1655

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	11/10/2015

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