MEDICARE: ANDREW W ULVIN DCPA

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	3840	MN

General Provider Information

NPI Number	:	1154639854
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW W ULVIN DCPA

Provider Business Mailing Address
First Line	:	30962 FENWAY AVE N
Second Line	:	P.O. BOX 298
City	:	STACY
State	:	MN
Zip	:	55079-9659
Country	:	US
Telephone Number	:	651-462-3243
Fax Number	:

Provider Business Practice Location Address
First Line	:	30962 FENWAY AVE N
Second Line	:	UNIT 400
City	:	STACY
State	:	MN
Zip	:	55079-9659
Country	:	US
Telephone Number	:	651-462-3243
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW WILLIAM ULVIN
Credential	:	D.C.
Telephone Number	:	651-462-3243

Provider Enumeration Date	:	09/16/2010
Last Update Date	:	02/22/2012

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