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Organization

MARTY GULLICKSON CHIROPRACTIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFERY THOMAS GULLICKSON DC (OWNER)
(952) 927-6639
Entity
Organization

Contact information

Practice address
17 10TH AVE S, HOPKINS, MN 55343
(952) 927-6639
(952) 927-0178
Mailing address
17 10TH AVE S, HOPKINS, MN 55343
(952) 927-6639
(952) 927-0178

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2596
MN
111N00000X
Chiropractor
2937
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
42G85MA
BLUE CROSS
MN
05
620071100
MN
Enumeration date
11/15/2006
Last updated
11/25/2014
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