Provider Demographics
NPI:1619169687
Name:GUSTAFSSON, TORE (DC)
Entity Type:Individual
Prefix:
First Name:TORE
Middle Name:
Last Name:GUSTAFSSON
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 1:15545 LOS GATOS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2567
Mailing Address - Country:US
Mailing Address - Phone:408-358-9800
Mailing Address - Fax:
Practice Address - Street 1:15545 LOS GATOS BLVD STE B
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2567
Practice Address - Country:US
Practice Address - Phone:408-358-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26870111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician