Provider Demographics
NPI:1730286907
Name:HAUSER, GARY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:HAUSER
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 1:1398 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2444
Mailing Address - Country:US
Mailing Address - Phone:636-947-4042
Mailing Address - Fax:636-947-7644
Practice Address - Street 1:1398 S 5TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2444
Practice Address - Country:US
Practice Address - Phone:636-947-4042
Practice Address - Fax:636-947-7644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE006093111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5016OtherBLUE CROSS / BLUE SHIELD
MO6141268-004OtherCIGNA
MOM0382OtherBC/BS OF ARKANSAS
MO5016OtherBLUE CROSS / BLUE SHIELD
MOU42373Medicare UPIN