Provider Demographics
NPI:1699852434
Name:LOVE, GARY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:LOVE
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 1:2828 E FORT LOWELL RD
Mailing Address - Street 2:BLDG. A
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1518
Mailing Address - Country:US
Mailing Address - Phone:520-326-5543
Mailing Address - Fax:520-323-8765
Practice Address - Street 1:2828 E FORT LOWELL RD
Practice Address - Street 2:BLDG. A
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1518
Practice Address - Country:US
Practice Address - Phone:520-326-5543
Practice Address - Fax:520-323-8765
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2056111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ41884Medicare UPIN