Provider Demographics
NPI:1003830373
Name:WALICKI, GARY (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WALICKI
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 1:22 SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-8536
Mailing Address - Country:US
Mailing Address - Phone:828-667-8000
Mailing Address - Fax:828-667-8001
Practice Address - Street 1:22 SARDIS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8536
Practice Address - Country:US
Practice Address - Phone:828-667-8000
Practice Address - Fax:828-667-8001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003830373OtherFACILITY NPI
NCU80780Medicare UPIN
NC890840JMedicaid