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NPI Code Detail

MEDICARE: DR. GARY NEEGARD D.C.

MEDICARE: DR. GARY NEEGARD 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
1111N00000XChiropractor1183MN

General Provider Information

NPI Number : 1871591370
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY NEEGARD D.C.
Provider Business Mailing Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-521-8869
Fax Number : 763-529-4228
Provider Business Practice Location Address
First Line : 3359 W BROADWAY AVE
Second Line :
City : ROBBINSDALE
State : MN
Zip : 55422-2928
Country : US
Telephone Number : 763-521-8869
Fax Number : 763-529-4228
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 06/06/2008

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