Provider Demographics
NPI:1215247788
Name:BROST, GERALD PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PAUL
Last Name:BROST
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 1:715 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-5034
Mailing Address - Country:US
Mailing Address - Phone:763-228-2212
Mailing Address - Fax:
Practice Address - Street 1:715 WILLOW GLEN DR
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-5034
Practice Address - Country:US
Practice Address - Phone:763-228-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1631111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor