MEDICARE: ST LUKES CHIROPRACTIC

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	171100000X	Acupuncturist
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1235715574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKES CHIROPRACTIC

Provider Business Mailing Address
First Line	:	28803 DAHLIA DR NW
Second Line	:
City	:	ISANTI
State	:	MN
Zip	:	55040-6331
Country	:	US
Telephone Number	:	608-957-6222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 BRIDGE ST NW STE 108
Second Line	:
City	:	SAINT FRANCIS
State	:	MN
Zip	:	55070-8631
Country	:	US
Telephone Number	:	763-452-0171
Fax Number	:	651-391-2077

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	GREGORY MICHAEL MCDONNELL
Credential	:	DC
Telephone Number	:	763-452-0171

Provider Enumeration Date	:	03/18/2021
Last Update Date	:	11/30/2023

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Directions to “ST LUKES CHIROPRACTIC ” Practice Location

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