Provider Demographics
NPI:1669682761
Name:GTM ENTERPRISES PA
Entity Type:Organization
Organization Name:GTM ENTERPRISES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-870-1500
Mailing Address - Street 1:2627 E FRANKLIN AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1103
Mailing Address - Country:US
Mailing Address - Phone:612-870-1500
Mailing Address - Fax:612-870-1551
Practice Address - Street 1:2627 E FRANKLIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1103
Practice Address - Country:US
Practice Address - Phone:612-870-1500
Practice Address - Fax:612-870-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty