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General NPI Number Information
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NPI Number | 1184123440
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Entity Type | Individual
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Provider Name | WESTON CARL GUSTAFSON DC
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Gender | Male
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 412 WEST AVE
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City | HOLDREGE
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State | NE
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Zip | 68949-2223
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Country | US
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Telephone | 308-991-2674
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Fax |
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Provider Business Mailing Address
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Address Line | 418 W 8TH AVE
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City | HOLDREGE
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State | NE
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Zip | 68949-1552
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Country | US
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Telephone | 308-991-2674
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1960
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License Number State | NE
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