Individual
DR. RYAN DENNIS GUSTAFSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1910 LUCILLE AVE, SUITE 1, KINGMAN, AZ 86401-4693
(928) 753-2047
(928) 753-2020
Mailing address
1910 LUCILLE AVE, SUITE 1, KINGMAN, AZ 86401-4693
(928) 753-2047
(928) 753-2020
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
7156
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1212439
CHIROSOURCE OF CA.
CA
01
—
1Z5906
HEALTH NET
AZ
01
—
229944
AP/IPA (AHCCCS)
AZ
01
—
3142303
AETNA
AZ
01
—
5291063
CCN/FIRST HEALTH
AZ
05
—
692659
—
AZ
01
—
AZ0937240
BC/BS OF AZ
AZ
Enumeration date
10/19/2006
Last updated
07/08/2007
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