Organization
LAKE MARION CHIROPRACTIC CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG ALAN COUILLARD DC (PRESIDENT)
(952) 469-8385
Entity
Organization
Contact information
Practice address
20176 HERITAGE DR, LAKEVILLE, MN 55044-6855
(952) 469-8385
(952) 469-1713
Mailing address
20176 HERITAGE DR, LAKEVILLE, MN 55044-6855
(952) 469-8385
(952) 469-1713
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
3955
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497741185
NPI # INDIVIDUAL
MN
Enumeration date
11/01/2006
Last updated
08/22/2020
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