Provider Demographics
NPI:1619128113
Name:DR. GARY L. CARR, DC, PLLC
Entity Type:Organization
Organization Name:DR. GARY L. CARR, DC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-386-8100
Mailing Address - Street 1:49 JAMESON RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-3274
Mailing Address - Country:US
Mailing Address - Phone:315-386-8100
Mailing Address - Fax:
Practice Address - Street 1:49 JAMESON RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3274
Practice Address - Country:US
Practice Address - Phone:315-386-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011006-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA 0772OtherMEDICARE
BA 0772OtherMEDICARE
V03826Medicare UPIN