Provider Demographics
NPI:1053485458
Name:CHENEY, GARY M (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:CHENEY
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 1:1605 S MARYLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-3312
Mailing Address - Country:US
Mailing Address - Phone:702-382-0211
Mailing Address - Fax:702-382-3994
Practice Address - Street 1:1605 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-3312
Practice Address - Country:US
Practice Address - Phone:702-382-0211
Practice Address - Fax:702-382-3994
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor