Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 493 | WY |
NPI | 1710079926 |
---|---|
Provider Name | Dr. Dwayne Steven Borgstrand |
First Address | Cody, WY 82414-3839 |
Second Address | Cody, WY 82414-3839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |