Organization
PREMIER HEALTH OF ROSEVILLE, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC GORDON KOEHLER DC (PRESIDENT/OWNER)
(651) 487-2198
Entity
Organization
Contact information
Practice address
1601 LARPENTEUR AVE, ST PAUL, MN 55113
(651) 487-2198
(651) 646-0283
Mailing address
1601 LARPENTEUR AVE, ST PAUL, MN 55113
(651) 487-2198
(651) 646-0283
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
761153600
—
MN
Enumeration date
05/21/2007
Last updated
07/17/2013
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