Individual
DR. CRAIG ALAN COUILLARD
Active
Individual
DR. CRAIG ALAN COUILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
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
Update your record
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