Healthcare Provider Details

I. General information

NPI: 1508497074
Provider Name (Legal Business Name): GAVIN CHARLES SPENNEWYN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 BUCK HILL RD STE E
BURNSVILLE MN
55306-6245
US

IV. Provider business mailing address

14300 BUCK HILL RD STE E
BURNSVILLE MN
55306-6245
US

V. Phone/Fax

Practice location:
  • Phone: 952-866-9010
  • Fax: 844-424-1518
Mailing address:
  • Phone: 952-866-9010
  • Fax: 844-424-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number119669
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6709
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: