Provider Demographics
NPI:1083798375
Name:ULVIN, ANDREW WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:WILLIAM
Last Name:ULVIN
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:PO BOX 298
Mailing Address - Street 2:P.O. BOX 237
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-0298
Mailing Address - Country:US
Mailing Address - Phone:651-462-3243
Mailing Address - Fax:
Practice Address - Street 1:397 BENCH ST.
Practice Address - Street 2:
Practice Address - City:TAYLORS FALLS
Practice Address - State:MN
Practice Address - Zip Code:55084-0237
Practice Address - Country:US
Practice Address - Phone:651-465-3190
Practice Address - Fax:651-344-6025
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4488447OtherMEDICA
MN79229OtherHEALTH PARTNERS
MN350052900OtherMEDICARE RAILROAD
MN4292979-00Medicaid
MN077J3TAOtherBLUE CROSS BLUE SHEILD
MN38939600Medicaid
MNU85229OtherHEALTH EOS
MN4488447OtherMEDICA