Provider Demographics
NPI:1609819762
Name:CHMELIK, GREGORY JOHN (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:CHMELIK
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 1:200 8TH AVE NW
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5068
Mailing Address - Country:US
Mailing Address - Phone:507-334-9400
Mailing Address - Fax:507-331-2210
Practice Address - Street 1:200 8TH AVE NW
Practice Address - Street 2:SUITE 5
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5068
Practice Address - Country:US
Practice Address - Phone:507-334-9400
Practice Address - Fax:507-331-2210
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU11441Medicare UPIN