Provider Demographics
NPI:1164834214
Name:RIPLEY, GREGORY (LAC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 JERSEY AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4968
Mailing Address - Country:US
Mailing Address - Phone:612-804-3804
Mailing Address - Fax:
Practice Address - Street 1:11900 WAYZATA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-2031
Practice Address - Country:US
Practice Address - Phone:612-804-3804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1708171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist