Provider Demographics
NPI:1043301211
Name:BORING, GARY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:BORING
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 1:12626 E 40 HWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5944
Mailing Address - Country:US
Mailing Address - Phone:816-353-9040
Mailing Address - Fax:816-353-0091
Practice Address - Street 1:12626 E 40 HWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5944
Practice Address - Country:US
Practice Address - Phone:816-353-9040
Practice Address - Fax:816-353-0091
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
002719Medicare ID - Type Unspecified