Provider Demographics
NPI:1205047800
Name:GUSTAFSON, ROBERT JOEL (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOEL
Last Name:GUSTAFSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:1055 PLUMMER CIR SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-2082
Mailing Address - Country:US
Mailing Address - Phone:507-292-7784
Mailing Address - Fax:507-226-8079
Practice Address - Street 1:2215 2ND ST SW
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4147
Practice Address - Country:US
Practice Address - Phone:507-292-7784
Practice Address - Fax:507-226-8079
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3598111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology