Provider Demographics
NPI:1336158492
Name:GERBER, JOHN ADRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ADRIAN
Last Name:GERBER
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 1:12265 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-3961
Mailing Address - Country:US
Mailing Address - Phone:763-757-8511
Mailing Address - Fax:763-757-0140
Practice Address - Street 1:12265 CENTRAL AVE NE
Practice Address - Street 2:SUITE 108
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-3961
Practice Address - Country:US
Practice Address - Phone:763-757-8511
Practice Address - Fax:763-757-0140
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2380111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0607282 00OtherMINNESOTA HEALTH CARE PRO
MNOHO94KEOtherBCBS
MN0167OtherPREFERREDONE
MN350000976Medicare UPIN