Provider Demographics
NPI:1871591370
Name:NEEGARD, GARY (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:NEEGARD
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 1:3359 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2928
Mailing Address - Country:US
Mailing Address - Phone:763-521-8869
Mailing Address - Fax:763-529-4228
Practice Address - Street 1:3359 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2928
Practice Address - Country:US
Practice Address - Phone:763-521-8869
Practice Address - Fax:763-529-4228
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002201Medicare ID - Type Unspecified