Provider Demographics
NPI:1679804322
Name:GUNN CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:GUNN CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:GUNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-492-8188
Mailing Address - Street 1:340 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2230
Mailing Address - Country:US
Mailing Address - Phone:801-492-8188
Mailing Address - Fax:801-492-3432
Practice Address - Street 1:340 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2230
Practice Address - Country:US
Practice Address - Phone:801-492-8188
Practice Address - Fax:801-492-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7540495-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty