MEDICARE: GREGORY MICHAEL MCDONNELL DC

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	4112	OH
2	171100000X	Acupuncturist	ACPU-00177	OH
3	171100000X	Acupuncturist	1074	MN
4	111N00000X	Chiropractor	4979	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	:	1619119138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MICHAEL MCDONNELL DC

Provider Business Mailing Address
First Line	:	28803 DAHLIA DR NW
Second Line	:
City	:	ISANTI
State	:	MN
Zip	:	55040-6331
Country	:	US
Telephone Number	:	763-452-0171
Fax Number	:	763-452-0171

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	:	513-912-0776

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

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	11/30/2023

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