Provider Demographics
NPI:1033208681
Name:GYMER, GARY B (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:GYMER
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 1:1250 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014
Mailing Address - Country:US
Mailing Address - Phone:269-964-1441
Mailing Address - Fax:269-964-0137
Practice Address - Street 1:1250 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014
Practice Address - Country:US
Practice Address - Phone:269-964-1441
Practice Address - Fax:269-964-0137
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4474102Medicaid
950A35023OtherBCBS
P55218OtherBCN
MI4474102Medicaid
950A35023OtherBCBS