Provider Demographics
NPI:1861031403
Name:BEENKEN, GREG DONALD (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:DONALD
Last Name:BEENKEN
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 1:10900 89TH AVE N STE 1
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4027
Mailing Address - Country:US
Mailing Address - Phone:763-432-3932
Mailing Address - Fax:763-432-0172
Practice Address - Street 1:10900 89TH AVE N STE 1
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4027
Practice Address - Country:US
Practice Address - Phone:763-432-3932
Practice Address - Fax:763-432-0172
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor