Individual
DR. LACIE MARIE GERHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DC
Contact information
Practice address
3333 W DIVISION ST, STE 122A, SAINT CLOUD, MN 56301-4549
(320) 281-5243
(320) 281-0093
Mailing address
3333 W DIVISION ST STE 122A, SAINT CLOUD, MN 56301-4549
(320) 281-5243
(320) 281-5243
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4483
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001J9
HSM ELECT
MN
01
—
350003002
MEDICARE RAIL ROAD
MN
01
—
663405
CHIROCARE
MN
05
—
706160900
—
MN
01
—
774S0MO
BCBS
MN
Enumeration date
12/20/2005
Last updated
06/11/2019
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