Gerhardson Chiropractic LLC
Organization Active NPI Chiropractor · Saint Cloud, MN
NPI 1396259883 · NPPES record last updated Nov 21, 2017
Key facts
- NPI
- 1396259883
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4483 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Lacie Marie Gerhardson, DC
- Title
- Owner
- Phone
- (320) 224-7069
Practitioners 13
-
Megan Berndt, DC
-
Maryn Borth, CMT
-
Amanda Bzdok, CMT
-
Alexandra Meyer, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
3333 W Division St
Ste 122A
Saint Cloud, MN 56301
Phone (320) 224-7069
310 3rd St NE
Waite Park, MN 56387
Phone (320) 281-5243
209 3rd St NE
Waite Park, MN 56387
Phone (320) 281-5243
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4483 | MN | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 706160900 | Medicaid | MN |
Other providers in Saint Cloud, MN
- Stephanie George
- Chelsea Gerads
- Jeffrey S Gerdes
- Terri T Gerdes
- Nicole Lee Gerding
- Lacie Marie Gerhardson
- Katie Nicole Germain
- Jennifer Lynn Gertgen
- Daniel J. Gerwing
- Rachael Diane Mueller Gessell
All providers in Saint Cloud, MN · Chiropractor in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.