Provider Demographics
NPI:1689086134
Name:ODERMANN, GINA LEIGH (DC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:LEIGH
Last Name:ODERMANN
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 1:4217 CHRISTY LN
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-3001
Mailing Address - Country:US
Mailing Address - Phone:218-591-5299
Mailing Address - Fax:
Practice Address - Street 1:3706 NICOLLET AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1237
Practice Address - Country:US
Practice Address - Phone:612-822-7509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor