Provider Demographics
NPI:1538334776
Name:GERVAIS, BRIAN D (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:GERVAIS
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 1:6104 OLSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4919
Mailing Address - Country:US
Mailing Address - Phone:612-500-2628
Mailing Address - Fax:
Practice Address - Street 1:6104 OLSON MEMORIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4919
Practice Address - Country:US
Practice Address - Phone:612-500-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6130111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician