MEDICARE: DR. JOHN GERARD HILPISCH 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	2432	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59404HI	OTHER	MN	BCBS NONPROVIDER

General Provider Information

NPI Number	:	1467677567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GERARD HILPISCH D.C.

Provider Business Mailing Address
First Line	:	8995 HIGHWAY 5
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-8900
Country	:	US
Telephone Number	:	651-749-5731
Fax Number	:	651-748-5730

Provider Business Practice Location Address
First Line	:	8995 HIGHWAY 5
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-8900
Country	:	US
Telephone Number	:	651-749-5731
Fax Number	:	651-748-5730

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/09/2007

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