Provider Demographics
NPI:1922166461
Name:DENVER, GREGORY EMIL (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EMIL
Last Name:DENVER
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 1:107 SE 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-3914
Mailing Address - Country:US
Mailing Address - Phone:218-326-0071
Mailing Address - Fax:218-327-1999
Practice Address - Street 1:107 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-3914
Practice Address - Country:US
Practice Address - Phone:218-326-0071
Practice Address - Fax:218-327-1999
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2456111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN790328600Medicaid
MN350003471Medicare PIN