Provider Demographics
NPI:1760498398
Name:AUSMUS, REGINA (DC)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:AUSMUS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-1563
Mailing Address - Country:US
Mailing Address - Phone:218-879-1556
Mailing Address - Fax:218-879-1568
Practice Address - Street 1:123 AVENUE C
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-1563
Practice Address - Country:US
Practice Address - Phone:218-879-1556
Practice Address - Fax:218-879-1568
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0465658Medicaid
IAU73163Medicare UPIN
IA0465658Medicaid