Provider Demographics
NPI:1073844973
Name:GUNN, BENJAMIN RUSSELL (DC)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RUSSELL
Last Name:GUNN
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 1:340 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2230
Mailing Address - Country:US
Mailing Address - Phone:801-492-8188
Mailing Address - Fax:801-492-3432
Practice Address - Street 1:340 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2230
Practice Address - Country:US
Practice Address - Phone:801-492-8188
Practice Address - Fax:801-492-3432
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7540495-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor