Provider Demographics
NPI:1700821923
Name:KOHOUT, MICHAEL ALAN (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:KOHOUT
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 1:1342 81ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2116
Mailing Address - Country:US
Mailing Address - Phone:763-784-3916
Mailing Address - Fax:763-784-3829
Practice Address - Street 1:1342 81ST AVE NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2116
Practice Address - Country:US
Practice Address - Phone:763-784-3916
Practice Address - Fax:763-784-3829
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2616111N00000X
MN114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231072OtherCHIRO CARE OF MN & ACN
MN0844OtherHSM, INC.
MN44-42014OtherMEDICA
MN4C917KOOtherBCBS OF MN
MN4C917KOOtherBCBS OF MN