Provider Demographics
NPI:1174678841
Name:GLEASON, GEOFFREY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:JAY
Last Name:GLEASON
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 1:14051 BURNHAVEN DR
Mailing Address - Street 2:SUITE #112
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4400
Mailing Address - Country:US
Mailing Address - Phone:952-898-1317
Mailing Address - Fax:
Practice Address - Street 1:14051 BURNHAVEN DR
Practice Address - Street 2:SUITE #112
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4400
Practice Address - Country:US
Practice Address - Phone:952-898-1317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor