Provider Demographics
NPI:1275614463
Name:ASH, GREGORY SCOTT (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SCOTT
Last Name:ASH
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 1:1510 TRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2742
Mailing Address - Country:US
Mailing Address - Phone:218-728-1049
Mailing Address - Fax:
Practice Address - Street 1:1118 E SUPERIOR ST
Practice Address - Street 2:FISHER CHIROPRACTIC CLINIC
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2217
Practice Address - Country:US
Practice Address - Phone:218-728-3639
Practice Address - Fax:218-728-2603
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1809111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI99112154Medicaid
MN005227200Medicaid
WI99112154Medicaid
MN005227200Medicaid