Provider Demographics
NPI:1265629885
Name:GANSEN, STEVEN ARNOLD (DC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ARNOLD
Last Name:GANSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:STEVEN
Other - Middle Name:ARNOLD
Other - Last Name:GANSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:210 N MERIDIAN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1828
Mailing Address - Country:US
Mailing Address - Phone:952-873-4275
Mailing Address - Fax:952-873-4288
Practice Address - Street 1:210 N MERIDIAN ST STE 1
Practice Address - Street 2:
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-1828
Practice Address - Country:US
Practice Address - Phone:952-873-4275
Practice Address - Fax:952-873-4288
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
3C336RIOtherBLUECROSS BLUESHIELD
3C336RIOtherBLUECROSS BLUESHIELD