Provider Demographics
NPI:1366088395
Name:GERNES, GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:GERNES
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 1:3311 53RD AVE N APT 106
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3446
Mailing Address - Country:US
Mailing Address - Phone:507-429-2280
Mailing Address - Fax:
Practice Address - Street 1:3311 53RD AVE N APT 106
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3446
Practice Address - Country:US
Practice Address - Phone:507-429-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6663111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor