Provider Demographics
NPI:1265441968
Name:GUNLOGSON, SAMUEL (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:GUNLOGSON
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 1:519 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2103
Mailing Address - Country:US
Mailing Address - Phone:320-269-3211
Mailing Address - Fax:320-269-9465
Practice Address - Street 1:519 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2103
Practice Address - Country:US
Practice Address - Phone:320-269-3211
Practice Address - Fax:320-269-9465
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN193G8COOtherBCBS
MN022526600Medicaid
MN694114OtherACN GROUP
MN022526600Medicaid
MNY43581Medicare UPIN