Healthcare Provider Details

I. General information

NPI: 1033547294
Provider Name (Legal Business Name): ARTHUR GUZHAGIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 10/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W LAKE ST SUITE 195
MINNEAPOLIS MN
55408-3154
US

IV. Provider business mailing address

1 W LAKE ST SUITE 195
MINNEAPOLIS MN
55408-3154
US

V. Phone/Fax

Practice location:
  • Phone: 612-259-7570
  • Fax: 612-886-3427
Mailing address:
  • Phone: 612-259-7570
  • Fax: 612-886-3427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: