Provider Demographics
NPI:1619025855
Name:NELSON, GINA CHRISTINE (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:CHRISTINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:CHRISTINE
Other - Last Name:FIALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:2730 COUNTY ROAD D E
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5624
Mailing Address - Country:US
Mailing Address - Phone:651-407-0802
Mailing Address - Fax:651-407-0812
Practice Address - Street 1:1526 MAHTOMEDI AVENUE
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115
Practice Address - Country:US
Practice Address - Phone:651-407-0802
Practice Address - Fax:651-407-0812
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN4887111N00000X
MN4887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN996697000Medicaid
MNV01156Medicare UPIN
MN996697000Medicaid