Individual
NIK GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
110105 PIONEER TRL W, SUITE 201, CHASKA, MN 55318-2680
(952) 512-4270
Mailing address
110105 PIONEER TRL W, SUITE 201, CHASKA, MN 55318-2680
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2824
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
225A2300X
REHABILITATION SERVICES
MN
Enumeration date
09/20/2016
Last updated
09/20/2016
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