Provider Demographics
NPI:1376828442
Name:ATCHISON, NOLAN BRENT (DC)
Entity Type:Individual
Prefix:
First Name:NOLAN
Middle Name:BRENT
Last Name:ATCHISON
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 1:682 KOEHNEN DR
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2517
Mailing Address - Country:US
Mailing Address - Phone:701-400-8044
Mailing Address - Fax:
Practice Address - Street 1:682 KOEHNEN DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2517
Practice Address - Country:US
Practice Address - Phone:701-400-8044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor