Provider Demographics
NPI:1114551306
Name:GULDAN, NICHOLAS JON (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JON
Last Name:GULDAN
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 1:108 CREEK LN S
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MN
Mailing Address - Zip Code:55352-1202
Mailing Address - Country:US
Mailing Address - Phone:952-492-6363
Mailing Address - Fax:
Practice Address - Street 1:4735 DAHLGREN RD STE 100
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MN
Practice Address - Zip Code:55315-4420
Practice Address - Country:US
Practice Address - Phone:952-594-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor