Provider Demographics
NPI:1538269675
Name:ASEBY-GESCH, MALIN ELISABETH (DC)
Entity type:Individual
Prefix:
First Name:MALIN
Middle Name:ELISABETH
Last Name:ASEBY-GESCH
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:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604
Mailing Address - Country:US
Mailing Address - Phone:218-387-2383
Mailing Address - Fax:218-387-2383
Practice Address - Street 1:501 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604-3105
Practice Address - Country:US
Practice Address - Phone:218-387-2383
Practice Address - Fax:218-387-2383
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN29G38SAOtherBC/BS OF MN GRP#
MN3570193-00OtherMINNESOTA CARE
MN29G39GEOtherBC/BS OF MN INDIVIDUAL
MN350051297OtherRAILROAD MEDICARE
MN350002091Medicare PIN
MN350051297OtherRAILROAD MEDICARE
MN3570193-00OtherMINNESOTA CARE