Provider Demographics
NPI:1821151150
Name:GUNLOGSON FAMILY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:GUNLOGSON FAMILY CHIROPRACTIC, P.A.
Other - Org Name:CORNERSTONE CHIROPRACTIC HEALTH PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNLOGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-269-3211
Mailing Address - Street 1:519 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2103
Mailing Address - Country:US
Mailing Address - Phone:320-269-3211
Mailing Address - Fax:320-269-9465
Practice Address - Street 1:519 S 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2103
Practice Address - Country:US
Practice Address - Phone:320-269-3211
Practice Address - Fax:320-269-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4692111N00000X
MN4741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN193G8COOtherGROUP NUMBER
MNC04094Medicare ID - Type UnspecifiedGROUP NUMBER