Active NPI
Brian D Gervais, D.C.
- Sports Physician Chiropractor
- Golden Valley, MN
National Provider Identifier
1538334776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Physician Chiropractor
- License
- 6130
- Practice address
- 6104 Olson Memorial Hwy
Suite 100
Golden Valley, MN 55422-4919 - Phone
- (612) 500-2628
- NPI assigned
- Apr 29, 2008
- Last updated
- Jun 13, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Physician Chiropractor | 111NS0005X | 6130 | MN | Primary |
Addresses
Primary practice location
6104 Olson Memorial Hwy
Suite 100
Golden Valley, MN 55422-4919
Mailing address
6104 Olson Memorial Hwy
Suite 100
Golden Valley, MN 55422-4919
Phone (612) 500-2628
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6130 | MN | MD | Sports Physician Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209427200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465776000000",
"number": "1538334776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6104 OLSON MEMORIAL HWY",
"address_2": "SUITE 100",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224919",
"telephone_number": "612-500-2628"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6104 OLSON MEMORIAL HWY",
"address_2": "SUITE 100",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224919",
"telephone_number": "612-500-2628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GERVAIS",
"first_name": "BRIAN",
"middle_name": "D",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-29",
"last_updated": "2016-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "111NS0005X",
"taxonomy_group": "",
"desc": "Chiropractor, Sports Physician",
"state": "MN",
"license": "6130",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Golden Valley, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.