Provider Demographics
NPI:1164435517
Name:DAHL, GREGORY J (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:DAHL
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:PO BOX 19252
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-0252
Mailing Address - Country:US
Mailing Address - Phone:612-823-1702
Mailing Address - Fax:612-823-5116
Practice Address - Street 1:ONE GROVELAND TERRACE
Practice Address - Street 2:#202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1174
Practice Address - Country:US
Practice Address - Phone:612-823-1702
Practice Address - Fax:612-224-9817
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62506DAOtherBLUE CROSS BLUE SHIELD
MN350001581Medicare ID - Type Unspecified
U-09715Medicare UPIN