DR. HAROLD KENNETH GILBERTSON, DC - NPI NUMBER 1124028998

Summary

Provider Name: DR. HAROLD KENNETH GILBERTSON, DC

NPI Number: 1124028998

Clasification: Technician, Other (247200000X)

Organization: ADVANTAGE PAIN MANAGEMENT INC

Address:
11903 ST. CHARLES ROCK RD.
ADVANTAGE PAIN MANAGEMENT
BRIDGETON, MO
ZIP 63044

Phone Number: (314) 739-2900



Detailed Information

DR. Harold Kenneth Gilbertson, DC is a technician in Bridgeton, MO with 42 years of experience. The provider is a collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user. The assigned NPI number for this provider is 1124028998 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOGAN COLLEGE OF CHIROPRACTIC
Graduation Year: 1972

The provider's business address is:

11903 ST. CHARLES ROCK RD.
ADVANTAGE PAIN MANAGEMENT
BRIDGETON, MO
ZIP 63044-623
Phone: (314) 739-2900
Fax: (314) 770-1623

The enumeration date for this NPI number is 7/22/2005 and was last updated on 9/26/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 247200000X Technician, Other No
2 111N00000X Chiropractor 003647 MO Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 MA1995001 MEDICARE UPIN
2 MA1995001 MEDICARE PIN
3 T89731 MEDICARE UPIN
4 990001637 MEDICARE ID-TYPE UNSPECIFIED MO

NPI Record

No. Field Name Field Value
1 NPI 1124028998
2 Entity Type Code 1
3 Provider Last Name Legal Name GILBERTSON
4 Provider First Name HAROLD
5 Provider Middle Name KENNETH
6 Provider Name Prefix Text DR.
7 Provider Credential Text DC
8 Provider First Line Business Practice Location Address 11903 ST. CHARLES ROCK RD.
9 Provider Second Line Business Practice Location Address ADVANTAGE PAIN MANAGEMENT
10 Provider Business Practice Location Address City Name BRIDGETON
11 Provider Business Practice Location Address State Name MO
12 Provider Business Practice Location Address Postal Code 630442623
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 3147392900
15 Provider Business Practice Location Address Fax Number 3147701623
16 Provider Enumeration Date 7/22/2005
17 Last Update Date 9/26/2012
18 Provider Gender Code M
19 Healthcare Provider Taxonomy Code 1 247200000X
20 Healthcare Provider Primary Taxonomy Switch 1 N
21 Healthcare Provider Taxonomy Code 2 111N00000X
22 Provider License Number 2 003647
23 Provider License Number State Code 2 MO
24 Healthcare Provider Primary Taxonomy Switch 2 Y
25 Other Provider Identifier 1 MA1995001
26 Other Provider Identifier Type Code 1 02
27 Other Provider Identifier 2 MA1995001
28 Other Provider Identifier Type Code 2 08
29 Other Provider Identifier 3 T89731
30 Other Provider Identifier Type Code 3 02
31 Other Provider Identifier 4 990001637
32 Other Provider Identifier Type Code 4 04
33 Other Provider Identifier State 4 MO
34 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.