Provider Demographics
NPI:1144226200
Name:EASTLUND, GREGORY EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:EASTLUND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 WHITE BEAR AVE N STE 10
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1321
Mailing Address - Country:US
Mailing Address - Phone:651-779-9282
Mailing Address - Fax:651-779-8247
Practice Address - Street 1:3035 WHITE BEAR AVE N STE 10
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1321
Practice Address - Country:US
Practice Address - Phone:651-779-9282
Practice Address - Fax:651-779-8247
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2591111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN672328400Medicaid