Provider Demographics
NPI:1669508693
Name:PRILEY, GERALD (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:PRILEY
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 1:1118 E SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2217
Mailing Address - Country:US
Mailing Address - Phone:218-728-3639
Mailing Address - Fax:218-728-2603
Practice Address - Street 1:1118 E SUPERIOR ST
Practice Address - Street 2:
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:2007-02-26
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN74678PROtherBLUE CROSS
MN509227200Medicaid
MN350051049OtherRAILROAD MEDICARE
MNT66024Medicare UPIN
MN74678PROtherBLUE CROSS