Provider Demographics
NPI:1245386655
Name:BILLINGSLEY, GARY RICHARD (DC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:RICHARD
Last Name:BILLINGSLEY
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 1:4940 S EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203
Mailing Address - Country:US
Mailing Address - Phone:317-784-9311
Mailing Address - Fax:317-784-9395
Practice Address - Street 1:4940 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203
Practice Address - Country:US
Practice Address - Phone:317-784-9311
Practice Address - Fax:317-784-9395
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000741A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34554Medicare UPIN
IN113050Medicare ID - Type Unspecified