Provider Demographics
NPI:1437504354
Name:GARST CLINIC PLC
Entity Type:Organization
Organization Name:GARST CLINIC PLC
Other - Org Name:GARST CLINIC OF CHIROPRATIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GARST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:540-297-3440
Mailing Address - Street 1:3609 BRANDON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1525
Mailing Address - Country:US
Mailing Address - Phone:540-297-3440
Mailing Address - Fax:540-297-9313
Practice Address - Street 1:3609 BRANDON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1525
Practice Address - Country:US
Practice Address - Phone:540-297-3440
Practice Address - Fax:540-297-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-28
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000405111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437504354Medicaid
VA460180OtherOPTUM
VA2089536OtherCIGNA
VAC09282OtherMEDICARE PTAN
VA0004158926OtherAETNA
VA142884OtherANTHEM
VA1437504354OtherUNITEDHEALTHCARE
VA1437504354OtherUNITEDHEALTHCARE
VA1437504354Medicaid