Provider Demographics
NPI:1417124017
Name:AYRES, GARY RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RAYMOND
Last Name:AYRES
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 1:6 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HERINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67449-2434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HERINGTON
Practice Address - State:KS
Practice Address - Zip Code:67449-2434
Practice Address - Country:US
Practice Address - Phone:785-499-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01/05181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor