Provider Demographics
NPI:1669495354
Name:CLEVELAND, GINA REBECCA (DC)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:REBECCA
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2439
Mailing Address - Country:US
Mailing Address - Phone:715-425-0333
Mailing Address - Fax:715-425-2273
Practice Address - Street 1:112 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2439
Practice Address - Country:US
Practice Address - Phone:715-425-0333
Practice Address - Fax:715-425-2273
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38906800Medicaid
WI38906800Medicaid