Individual
DR. CRAIG ALAN COUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
9202 202ND ST W, SUITE 203, LAKEVILLE, MN 55044-7915
(952) 469-8385
(952) 469-1713
Mailing address
9202 202ND ST W, SUITE 203, 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
—
350002308
MEDICAR PTAN
MN
01
—
411991603
FEDERAL TAX ID #
MN
05
—
727678800
—
MN
Enumeration date
09/27/2005
Last updated
09/06/2011
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