Provider Demographics
NPI:1316937311
Name:GEBECK, CHRISTOPHER JON (AT,C)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JON
Last Name:GEBECK
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:TWO HARBORS
Mailing Address - State:MN
Mailing Address - Zip Code:55616-1350
Mailing Address - Country:US
Mailing Address - Phone:218-834-3088
Mailing Address - Fax:
Practice Address - Street 1:402 E 2ND ST
Practice Address - Street 2:DULUTH CLINIC - SPORTS MEDICINE
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1906
Practice Address - Country:US
Practice Address - Phone:218-590-1057
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer