Provider Demographics
NPI:1942834734
Name:BRONSON, GAVIN (DC)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:BRONSON
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 1:2837 LYNDALE AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2109
Mailing Address - Country:US
Mailing Address - Phone:612-872-9596
Mailing Address - Fax:
Practice Address - Street 1:5201 EDEN AVE STE 190
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436-2368
Practice Address - Country:US
Practice Address - Phone:952-920-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6713111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor