Provider Demographics
NPI:1083087803
Name:SHURSON, CAILIN MARIE (DC)
Entity Type:Individual
Prefix:
First Name:CAILIN
Middle Name:MARIE
Last Name:SHURSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9202 202ND ST W
Mailing Address - Street 2:STE 203
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-7915
Mailing Address - Country:US
Mailing Address - Phone:952-469-8385
Mailing Address - Fax:952-469-1713
Practice Address - Street 1:9202 202ND ST W
Practice Address - Street 2:STE 203
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-7915
Practice Address - Country:US
Practice Address - Phone:952-469-8385
Practice Address - Fax:952-469-1713
Is Sole Proprietor?:No
Enumeration Date:2015-11-02
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6133111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400255331Medicare PIN