MEDICARE: MR. DUSTIN ELMER ESLINGER M.A. R/ATC

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	2255A2300X	Athletic Trainer	1876	MN

General Provider Information

NPI Number	:	1457388795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DUSTIN ELMER ESLINGER M.A. R/ATC

Provider Business Mailing Address
First Line	:	3845 119TH AVE NW APT 35
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-6721
Country	:	US
Telephone Number	:	586-354-1520
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 BRIDGE ST NW STE 111
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-8631
Country	:	US
Telephone Number	:	763-753-8804
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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