Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4988 | MN |
NPI | 1003005018 |
---|---|
Provider Name | Dr. Andrew Robert Coulson |
First Address | Maple Grove, MN 55369-7016 |
Second Address | Maple Grove, MN 55369-7016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2007 |
Last Update Date | 16/10/2007 |