Provider Demographics
NPI:1710002175
Name:KOEHLER, ERIC GORDON (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:GORDON
Last Name:KOEHLER
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 1:1545 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:FALCON HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6316
Mailing Address - Country:US
Mailing Address - Phone:651-487-2198
Mailing Address - Fax:651-646-0283
Practice Address - Street 1:1545 LARPENTEUR AVE W
Practice Address - Street 2:
Practice Address - City:FALCON HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55113-6316
Practice Address - Country:US
Practice Address - Phone:651-487-2198
Practice Address - Fax:651-646-0283
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3880111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor