Provider Demographics
NPI:1386839223
Name:GUEST, GARY MARK (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MARK
Last Name:GUEST
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 1:2304 N 7TH AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2597
Mailing Address - Country:US
Mailing Address - Phone:406-586-7641
Mailing Address - Fax:406-582-4181
Practice Address - Street 1:2304 N 7TH AVE
Practice Address - Street 2:SUITE E
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2571
Practice Address - Country:US
Practice Address - Phone:406-586-7641
Practice Address - Fax:406-582-4181
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM000004672OtherMEDICARE PTAN
MT040980OtherBCBS
MT162279Medicaid
MT000085216Medicare PIN