Provider Demographics
NPI:1437167897
Name:GENTRY, GARY DWAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DWAINE
Last Name:GENTRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:SUITE #122
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2439
Mailing Address - Country:US
Mailing Address - Phone:972-492-5670
Mailing Address - Fax:972-394-9959
Practice Address - Street 1:3730 N JOSEY LN
Practice Address - Street 2:SUITE #122
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2484
Practice Address - Country:US
Practice Address - Phone:972-492-5670
Practice Address - Fax:092-394-9959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX2761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601063Medicare PIN