Provider Demographics
NPI:1750524187
Name:SHAUN R GIFFORD D.C. P.S.C.
Entity type:Organization
Organization Name:SHAUN R GIFFORD D.C. P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-412-0486
Mailing Address - Street 1:1064 COUNTY ROAD 42 E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4652
Mailing Address - Country:US
Mailing Address - Phone:952-432-4252
Mailing Address - Fax:952-432-4254
Practice Address - Street 1:1064 COUNTY ROAD 42 E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4652
Practice Address - Country:US
Practice Address - Phone:952-432-4252
Practice Address - Fax:952-432-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3889261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center