Provider Demographics
NPI:1437113594
Name:HOPKINS, GARY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:HOPKINS
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 1:5800 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-3400
Mailing Address - Country:US
Mailing Address - Phone:260-456-4074
Mailing Address - Fax:260-456-4074
Practice Address - Street 1:5800 FAIRFIELD AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46807-3400
Practice Address - Country:US
Practice Address - Phone:260-456-4074
Practice Address - Fax:260-456-4074
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001115A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100332590AMedicaid
IN135800Medicare PIN
INT34583Medicare UPIN