Provider Demographics
NPI:1659457257
Name:SUTTON, GARY B (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:SUTTON
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 1:1097 GEORGES FAIRCHANCE RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-1595
Mailing Address - Country:US
Mailing Address - Phone:724-564-9729
Mailing Address - Fax:724-564-0599
Practice Address - Street 1:1097 GEORGES FAIRCHANCE RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1595
Practice Address - Country:US
Practice Address - Phone:724-564-9729
Practice Address - Fax:724-564-0599
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001338-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASU115478Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER