Provider Demographics
NPI:1265435812
Name:GUDGEL, JAMES WALKER (DC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALKER
Last Name:GUDGEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:821 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56283-1801
Mailing Address - Country:US
Mailing Address - Phone:507-637-8585
Mailing Address - Fax:507-637-8649
Practice Address - Street 1:821 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:REDWOOD FALLS
Practice Address - State:MN
Practice Address - Zip Code:56283-1801
Practice Address - Country:US
Practice Address - Phone:507-637-8585
Practice Address - Fax:507-637-8649
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1888111N00000X
MN5776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN784527800Medicaid
MN47209GUOtherBLUE CROSS
MNC07248Medicare ID - Type Unspecified
MN784527800Medicaid