MEDICARE: DR. GREGORY EUGENE EASTLUND D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2591	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144226200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY EUGENE EASTLUND D.C.

Provider Business Mailing Address
First Line	:	3035 WHITE BEAR AVE N STE 10
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1321
Country	:	US
Telephone Number	:	651-779-9282
Fax Number	:	651-779-8247

Provider Business Practice Location Address
First Line	:	3035 WHITE BEAR AVE N STE 10
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1321
Country	:	US
Telephone Number	:	651-779-9282
Fax Number	:	651-779-8247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	03/09/2021

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