Provider Demographics
NPI:1336294578
Name:FIMREITE, GORDON K (DC)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:K
Last Name:FIMREITE
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 1:17191 COUNTY HIGHWAY X
Mailing Address - Street 2:
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729-8057
Mailing Address - Country:US
Mailing Address - Phone:715-723-3333
Mailing Address - Fax:
Practice Address - Street 1:17191 COUNTY HIGHWAY X
Practice Address - Street 2:
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729-8057
Practice Address - Country:US
Practice Address - Phone:715-723-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008054111N00000X
WI3363-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP60414OtherBCBS
ILP60414OtherBCBS
ILU65331Medicare UPIN