NPIMap

Organization Active NPI

Gerhardson Chiropractic LLC

  • Chiropractor
  • Saint Cloud, MN
National Provider Identifier
1396259883
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4483 Issued in MN
Legal business name
GERHARDSON CHIROPRACTIC LLC
Practice address
3333 W Division St
Saint Cloud, MN 56301-4515
Phone
(320) 224-7069
NPI assigned
Nov 21, 2017
Last updated
Nov 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Lacie Marie Gerhardson, DCNPI 1407832512
Title
Owner
Phone
(320) 224-7069

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4483 MN Primary

Addresses

Primary practice location

3333 W Division St
Saint Cloud, MN 56301-4515

Mailing address

3508 16TH Ave S
Saint Cloud, MN 56301-4578
Phone (320) 224-7069

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180108000025 MN Part B Supplier - Clinic/Group Practice 1951660513 Receives reassigned benefits from 5 practitioners
Practice locations: Foley, MN; Waite Park, MN

National Provider Directory

National Provider Directory

Locations

3333 W Division St
Ste 122A
Saint Cloud, MN 56301
Phone (320) 281-5243

209 3rd St NE
Waite Park, MN 56387
Phone (320) 281-5243

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1396259883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3508 16TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014578",
            "telephone_number": "320-224-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 W DIVISION ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014515",
            "telephone_number": "320-224-7069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERHARDSON CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-21",
        "last_updated": "2017-11-21",
        "status": "A",
        "authorized_official_last_name": "GERHARDSON",
        "authorized_official_first_name": "LACIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "320-224-7069",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4483",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.