Provider Demographics
NPI:1205958105
Name:HINCK, GLORI (DC)
Entity type:Individual
Prefix:
First Name:GLORI
Middle Name:
Last Name:HINCK
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 1:1800 CLINTON AVE APT 107
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2469
Mailing Address - Country:US
Mailing Address - Phone:612-670-0527
Mailing Address - Fax:
Practice Address - Street 1:1800 CLINTON AVE APT 107
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2469
Practice Address - Country:US
Practice Address - Phone:612-670-0527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN030327500Medicaid
MN3438OtherLICENSE
411867390OtherEIN
MN3438OtherLICENSE
MN350002049Medicare PIN