Provider Demographics
NPI:1578621561
Name:KEHRES, GARY AUGUST (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:AUGUST
Last Name:KEHRES
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 1:2155 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2302
Mailing Address - Country:US
Mailing Address - Phone:540-774-0910
Mailing Address - Fax:540-774-0910
Practice Address - Street 1:2155 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2302
Practice Address - Country:US
Practice Address - Phone:540-774-0910
Practice Address - Fax:540-774-0910
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000235Medicare ID - Type Unspecified
VAT78324Medicare UPIN