Provider Demographics
NPI:1043304082
Name:CARR, GARY L (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:CARR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 JAMESON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3274
Mailing Address - Country:US
Mailing Address - Phone:315-386-8100
Mailing Address - Fax:315-386-8101
Practice Address - Street 1:49 JAMESON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3274
Practice Address - Country:US
Practice Address - Phone:315-386-8100
Practice Address - Fax:315-386-8101
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011006-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06-1757494OtherTAX IDENTIFICATION NUMBER
NYX011006-1OtherLICENSE
NYX011006-1OtherLICENSE