Provider Demographics
NPI:1083779029
Name:MAGNUSON, DAVID C (DIPL AC, LAC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:DIPL AC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-3450
Mailing Address - Country:US
Mailing Address - Phone:701-738-8888
Mailing Address - Fax:701-738-8888
Practice Address - Street 1:117 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-3450
Practice Address - Country:US
Practice Address - Phone:701-738-8888
Practice Address - Fax:701-738-8888
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN 1284171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist