Provider Demographics
NPI:1235240680
Name:CARR, GAVIN WALTER II (DC)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:WALTER
Last Name:CARR
Suffix:II
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 1:489 MIDDLEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1347
Mailing Address - Country:US
Mailing Address - Phone:650-326-7000
Mailing Address - Fax:650-326-7002
Practice Address - Street 1:489 MIDDLEFIELD RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1347
Practice Address - Country:US
Practice Address - Phone:650-326-7000
Practice Address - Fax:650-326-7002
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0199460OtherBLUE SHIELD
CADC0199460OtherBLUE SHIELD