Individual provider Active NPI

Andrew Robert Coulson, D.C.

  • Chiropractor
  • Maple Grove, MN
National Provider Identifier
1003005018
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4988 Issued in MN
Practice address
13800 83Rd Way N
Suite 108
Maple Grove, MN 55369-7016
Phone
(763) 494-0828
Fax
(763) 494-0856
NPI assigned
Oct 16, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4988 MN Primary

Addresses

Primary practice location

13800 83Rd Way N
Suite 108
Maple Grove, MN 55369-7016

Mailing address

13800 83Rd Way N
Suite 108
Maple Grove, MN 55369-7016
Phone (763) 494-0828

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080326001009 MN Practitioner - Chiropractic 8628154903 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coulson Chiropractic, LLCGroup PAC ID 7618053992, 2 clinicians

Practice addresses (Care Compare)

13800 83Rd Way N
Suite 108
Maple Grove, MN 55369-7016
Phone (763) 494-0828

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4988MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Coulson Chiropractic, LLC Chiropractor CurrentSince Aug 13, 2007 Accepting new patients
Gregory P Goihl P.a Chiropractor PastSince Aug 13, 2007 Accepting new patients

Locations

13800 83rd Way N
Ste 108
Maple Grove, MN 55369
Phone (763) 273-5486

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192492800000",
    "number": "1003005018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 83RD WAY N",
            "address_2": "SUITE 108",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697016",
            "telephone_number": "763-494-0828",
            "fax_number": "763-494-0856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 83RD WAY N",
            "address_2": "SUITE 108",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553697016",
            "telephone_number": "763-494-0828",
            "fax_number": "763-494-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COULSON",
        "first_name": "ANDREW",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-16",
        "last_updated": "2007-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.