Provider Demographics
NPI:1073664272
Name:WARREN, GARY LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:WARREN
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 1:1170 W PECKHAM LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5220
Mailing Address - Country:US
Mailing Address - Phone:775-827-6896
Mailing Address - Fax:775-828-5433
Practice Address - Street 1:3045 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4502
Practice Address - Country:US
Practice Address - Phone:775-828-3456
Practice Address - Fax:775-828-5433
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00508111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDC508AMedicare ID - Type Unspecified