Ryan Dennis Gustafson, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

7156 Issued in AZ

Practice address

1910 Lucille Ave
Suite 1
Kingman, AZ 86401-4693

Phone

(928) 753-2047

Fax

(928) 753-2020

NPI assigned

Oct 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kingman Regional Medical Center Hospital, Kingman, AZ, CCN 030055

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kingman Chiropractic Clinic PC

  dba Dennis D and Ryan D Gustafson DC

  • Chiropractor
  • Kingman, AZ
  • NPI 1003970930
  Medicare reassignment NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kingman Healthcare, Inc

  dba Kingman Regional Medical Center

  • General Acute Care Hospital
  • Kingman, AZ
  • NPI 1265423917
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407938798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 LUCILLE AVE",
            "address_2": "SUITE 1",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014693",
            "telephone_number": "928-753-2047",
            "fax_number": "928-753-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 LUCILLE AVE",
            "address_2": "SUITE 1",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014693",
            "telephone_number": "928-753-2047",
            "fax_number": "928-753-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "RYAN",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "3142303",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS OF AZ",
            "identifier": "AZ0937240",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROSOURCE OF CA.",
            "identifier": "1212439",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1Z5906",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN/FIRST HEALTH",
            "identifier": "5291063",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "692659",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AP/IPA (AHCCCS)",
            "identifier": "229944",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tanja Gromala
• Christopher Groves
• Theresa Vila Grumbles, M.A.
• Maria Fernanda Guardia, PA
• Laura Joy Gustafson, D.C.
• Bachar Hachem, DO
• Hackberry School District#3
• Jamie Renee Hairston, MS, LASAC
• Emily Lynn Hall, M.ED
• Timothy Hamburg

• Chiropractor in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Chiropractor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.