Provider Demographics
NPI:1982453593
Name:GIMBERLIN, TANER LEON (DC)
Entity type:Individual
Prefix:
First Name:TANER
Middle Name:LEON
Last Name:GIMBERLIN
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 ROBERT ST S APT 145
Mailing Address - Street 2:
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-4093
Mailing Address - Country:US
Mailing Address - Phone:320-368-0449
Mailing Address - Fax:
Practice Address - Street 1:17725 KENWOOD TRL STE 3
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-9455
Practice Address - Country:US
Practice Address - Phone:952-683-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7161111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty