MEDICARE: CELIA MARIE MCDOUGLE DC

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	6383	MN

General Provider Information

NPI Number	:	1508385709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA MARIE MCDOUGLE DC

Provider Business Mailing Address
First Line	:	8509 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2119
Country	:	US
Telephone Number	:	763-425-4577
Fax Number	:

Provider Business Practice Location Address
First Line	:	8509 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2119
Country	:	US
Telephone Number	:	763-425-4577
Fax Number	:

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

Provider Enumeration Date	:	09/19/2017
Last Update Date	:	07/21/2022

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Directions to “ CELIA MARIE MCDOUGLE DC” Practice Location

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