Provider Demographics
NPI:1336123033
Name:SCHOLL, GARY L (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:SCHOLL
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 1:63 GLACIER WAY
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7753
Mailing Address - Country:US
Mailing Address - Phone:703-339-5458
Mailing Address - Fax:703-339-0406
Practice Address - Street 1:7700 GUNSTON PLZ # A
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1897
Practice Address - Country:US
Practice Address - Phone:703-339-5458
Practice Address - Fax:703-339-0406
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556242111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1371889OtherAETNA HMO
VA2125155OtherMAMSI
VA666698OtherACN
VA7701844OtherAETNA
VA242327OtherKAISER
VAH894-0002OtherCAREFIRST
VA1050910OtherASHN
VA669923OtherNCPPO
VA115868OtherANTHEM BC/BS