Provider Demographics
NPI:1366504987
Name:GUSSO, TRENT
Entity Type:Individual
Prefix:
First Name:TRENT
Middle Name:
Last Name:GUSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 S MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-5124
Mailing Address - Country:US
Mailing Address - Phone:605-361-0870
Mailing Address - Fax:
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:SD
Practice Address - Zip Code:57349
Practice Address - Country:US
Practice Address - Phone:605-772-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor