MEDICARE: GERALD PRILEY 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	2330	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	350051049	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74678PR	OTHER	MN	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669508693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD PRILEY D.C.

Provider Business Mailing Address
First Line	:	1118 E SUPERIOR ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2217
Country	:	US
Telephone Number	:	218-728-3639
Fax Number	:	218-728-2603

Provider Business Practice Location Address
First Line	:	1118 E SUPERIOR ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2217
Country	:	US
Telephone Number	:	218-728-3639
Fax Number	:	218-728-2603

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	02/15/2011

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Directions to “ GERALD PRILEY D.C.” Practice Location

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