Lake Marion Chiropractic Center PA

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

3955 Issued in MN

Legal business name

LAKE MARION CHIROPRACTIC CENTER PA

Practice address

20176 Heritage Dr
Lakeville, MN 55044-6855

Phone

(952) 469-8385

Fax

(952) 469-1713

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Craig Alan Couillard, DCNPI 1497741185

Title

President

Phone

(952) 469-8385

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Alan Couillard, DC

  • Sports Physician Chiropractor
  • Lakeville, MN
  • NPI 1497741185
  Medicare reassignment NPD Authorized official
• Brian Dean Betts, DC

  • Chiropractor
  • Lakeville, MN
  • NPI 1659355006
  NPD (past)
• Cynthia Susanna Vansickler, D.C.

  • Chiropractor
  • Lakeville, MN
  • NPI 1235495615
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1225115405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20176 HERITAGE DR",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446855",
            "telephone_number": "952-469-8385",
            "fax_number": "952-469-1713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20176 HERITAGE DR",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446855",
            "telephone_number": "952-469-8385",
            "fax_number": "952-469-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE MARION CHIROPRACTIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COUILLARD",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-469-8385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "MN",
            "license": "3955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI # INDIVIDUAL",
            "identifier": "1497741185",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kolby Kulas, DDS
• Mallory Kurkosky, MA, LPCC
• Jennifer Jacqueline Felinski Kurtz-Port, PSYD
• Thomas J Kyllo, PT
• John E Laco, DPM
• Lake Marion Dental Care
• Lakeville Assisted Living LLC
• Lakeville Behavioral Health, LLC
• Lakeville Community Chiropractic
• Lakeville Dental Associates, P.a.

• Sports Physician Chiropractor in Lakeville, MN
• Providers in Lakeville, MN by specialty
• Sports Physician Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.