Provider Demographics
NPI:1235249434
Name:SPERO, GARY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:SPERO
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 1:10 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-3724
Mailing Address - Country:US
Mailing Address - Phone:631-691-1070
Mailing Address - Fax:631-691-1073
Practice Address - Street 1:10 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-3724
Practice Address - Country:US
Practice Address - Phone:631-691-1070
Practice Address - Fax:631-691-1073
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004188-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX22831Medicare PIN
NYX22831Medicare ID - Type Unspecified
X22831Medicare PIN