Provider Demographics
NPI:1003005018
Name:COULSON, ANDREW ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROBERT
Last Name:COULSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 83RD WAY N
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7016
Mailing Address - Country:US
Mailing Address - Phone:763-494-0828
Mailing Address - Fax:763-494-0856
Practice Address - Street 1:13800 83RD WAY N
Practice Address - Street 2:SUITE 108
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7016
Practice Address - Country:US
Practice Address - Phone:763-494-0828
Practice Address - Fax:763-494-0856
Is Sole Proprietor?:No
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4988111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor