Provider Demographics
NPI:1497828008
Name:GAUSTAD, DANIEL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ROBERT
Last Name:GAUSTAD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2736 LYNDALE AVE S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-1309
Mailing Address - Country:US
Mailing Address - Phone:612-327-1447
Mailing Address - Fax:612-677-3368
Practice Address - Street 1:2736 LYNDALE AVE S
Practice Address - Street 2:SUITE 210
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-1309
Practice Address - Country:US
Practice Address - Phone:612-327-1447
Practice Address - Fax:612-677-3368
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor