Provider Demographics
NPI:1104826866
Name:GAMACHE, GARY BRYCE (DC FIAMA DIPL AC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRYCE
Last Name:GAMACHE
Suffix:
Gender:M
Credentials:DC FIAMA DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8128
Mailing Address - Country:US
Mailing Address - Phone:605-342-4333
Mailing Address - Fax:605-348-6420
Practice Address - Street 1:2720 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8128
Practice Address - Country:US
Practice Address - Phone:605-342-4333
Practice Address - Fax:605-348-6420
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD572111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0085088OtherWELLMARK BCBS
SD7600140Medicaid
T66525Medicare UPIN
SD0085088OtherWELLMARK BCBS