Provider Demographics
NPI:1346389897
Name:BULSON, ANDREA MAE (DC)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MAE
Last Name:BULSON
Suffix:
Gender:F
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:COLERAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55722-0721
Mailing Address - Country:US
Mailing Address - Phone:952-200-2743
Mailing Address - Fax:
Practice Address - Street 1:1751 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2586
Practice Address - Country:US
Practice Address - Phone:218-326-2828
Practice Address - Fax:218-326-2516
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4923111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor