Organization
GERHARDSON CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LACIE MARIE GERHARDSON DC (OWNER)
(320) 224-7069
Entity
Organization
Contact information
Practice address
3333 W DIVISION ST, SAINT CLOUD, MN 56301-4515
(320) 224-7069
Mailing address
3508 16TH AVE S, SAINT CLOUD, MN 56301-4578
(320) 224-7069
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4483
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
706160900
—
MN
Enumeration date
11/21/2017
Last updated
11/21/2017
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