Provider Demographics
NPI:1821413279
Name:SKALICKY, GRETCHEN BLAUFUSS (DC)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:BLAUFUSS
Last Name:SKALICKY
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 1:510 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1706
Mailing Address - Country:US
Mailing Address - Phone:320-629-8070
Mailing Address - Fax:
Practice Address - Street 1:510 2ND ST SE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1706
Practice Address - Country:US
Practice Address - Phone:320-629-8070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor