Provider Demographics
NPI:1992774806
Name:BELTING, GREGORY BLAINE (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BLAINE
Last Name:BELTING
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 1:4137 WOODLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55014-3529
Mailing Address - Country:US
Mailing Address - Phone:763-786-5581
Mailing Address - Fax:763-784-5349
Practice Address - Street 1:4137 WOODLAND ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MN
Practice Address - Zip Code:55014-3529
Practice Address - Country:US
Practice Address - Phone:763-786-5581
Practice Address - Fax:763-784-5349
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2364111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN391228100Medicaid