Provider Demographics
NPI:1366529752
Name:HOLMBERG, GREGORY ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLAN
Last Name:HOLMBERG
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:#8 3RD STREET NW
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55316
Mailing Address - Country:US
Mailing Address - Phone:763-493-3594
Mailing Address - Fax:763-493-3594
Practice Address - Street 1:#8 3RD STREET NW
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55316
Practice Address - Country:US
Practice Address - Phone:763-493-3594
Practice Address - Fax:763-493-3594
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0B175H0OtherBCBS MN
MN07257H0OtherBCBS MN