Provider Demographics
NPI:1023023876
Name:ROVIN, GARY L (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:ROVIN
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 1:4 EXECUTIVE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2016
Mailing Address - Country:US
Mailing Address - Phone:618-239-6300
Mailing Address - Fax:
Practice Address - Street 1:4 EXECUTIVE WOODS CT
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2016
Practice Address - Country:US
Practice Address - Phone:618-239-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL38008126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor