Provider Demographics
NPI:1952557134
Name:HEBEISEN, GREGG C (DC)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:C
Last Name:HEBEISEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5188
Mailing Address - Country:US
Mailing Address - Phone:763-571-9499
Mailing Address - Fax:763-502-0364
Practice Address - Street 1:6280 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5188
Practice Address - Country:US
Practice Address - Phone:763-571-9499
Practice Address - Fax:763-502-0364
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC2214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1026232OtherPAS
MN13N21HEOtherBLUECROSS BLUESHIELD
TX44448225OtherMEDICA
MN665950OtherAMERICAS PPO
GA665950OtherDEFINITY HEALTH
237P3HEOtherBLUECROSS BLUESHIELD
MN13N31HEOtherBLUECROSS BLUE SHIELD
MN767527500Medicaid
MN01005230OtherPREFERED ONE
MN4425650OtherMEDICA
IL47676807801OtherCIGNA HEALTH CARE
UT230321OtherUNITED HEALTHCARE
CA231414OtherAMERICAN SPECIALTY HEALTH GROUP
MN377OtherHEALTH SERVICE MGMT
MN767527500Medicaid
MN350000217Medicare PIN