Provider Demographics
NPI:1922280833
Name:GUNN CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:GUNN CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-628-2888
Mailing Address - Street 1:410 W SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4553
Mailing Address - Country:US
Mailing Address - Phone:435-628-2888
Mailing Address - Fax:435-628-3570
Practice Address - Street 1:410 W SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4553
Practice Address - Country:US
Practice Address - Phone:435-628-2888
Practice Address - Fax:435-628-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528875732001Medicaid
UTU87334Medicare UPIN
UT000057275Medicare PIN