Individual
LANE N GUNNERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
1325 NW 4TH ST # 200, GRAND RAPIDS, MN 55744-2209
(218) 326-4022
Mailing address
1325 NW 4TH ST # 200, GRAND RAPIDS, MN 55744-2209
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3335
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281827200
—
MN
01
—
350052380
RAILROAD MEDICARE
MN
01
—
4C807GU
BCBS
MN
Enumeration date
07/20/2006
Last updated
08/01/2013
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