Provider Demographics
NPI:1710079926
Name:BORGSTRAND, DWAYNE STEVEN (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:STEVEN
Last Name:BORGSTRAND
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3839
Mailing Address - Country:US
Mailing Address - Phone:307-587-6313
Mailing Address - Fax:
Practice Address - Street 1:832 19TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3839
Practice Address - Country:US
Practice Address - Phone:307-587-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY493111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic