Provider Demographics
NPI:1609960152
Name:SPUNT, GARY STEWART (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:STEWART
Last Name:SPUNT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:SPUNT
Other - Middle Name:
Other - Last Name:FAMILY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6611 ARLINGTON AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-1959
Mailing Address - Country:US
Mailing Address - Phone:951-359-1131
Mailing Address - Fax:951-359-1229
Practice Address - Street 1:2515 MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3407
Practice Address - Country:US
Practice Address - Phone:805-927-5292
Practice Address - Fax:805-927-0354
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 21810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0218100Medicare ID - Type Unspecified