Provider Demographics
NPI:1639718737
Name:CLYMAN, GARY J (LAC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:CLYMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16816 RIVERSIDE DR FL 1
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2886
Mailing Address - Country:US
Mailing Address - Phone:312-446-8218
Mailing Address - Fax:
Practice Address - Street 1:5623 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2220
Practice Address - Country:US
Practice Address - Phone:708-863-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL46-4032809OtherGOVERNMENT