Provider Demographics
NPI:1407930688
Name:GUSE, SHAWN LAVERNE (DC)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:LAVERNE
Last Name:GUSE
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 1:13704 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4404
Mailing Address - Country:US
Mailing Address - Phone:763-425-5550
Mailing Address - Fax:763-425-6681
Practice Address - Street 1:13704 GROVE DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4404
Practice Address - Country:US
Practice Address - Phone:763-425-5550
Practice Address - Fax:763-425-6681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6899217OtherMN TAX ID #
MN302M2GUOtherBCBS PROVIDER #
MNVO1415Medicare UPIN