Healthcare Provider Details

I. General information

NPI: 1467445817
Provider Name (Legal Business Name): WAYNE ERRON GUDGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E BRIDGE ST
REDWOOD FALLS MN
56283-1801
US

IV. Provider business mailing address

821 E BRIDGE ST
REDWOOD FALLS MN
56283-1801
US

V. Phone/Fax

Practice location:
  • Phone: 507-637-8585
  • Fax: 507-637-8649
Mailing address:
  • Phone: 507-637-8585
  • Fax: 507-637-8649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMN3465
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8001749
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: