Provider Demographics
NPI:1770680878
Name:FAVERO, GARY L (DC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:FAVERO
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 1:109 S WATER ST
Mailing Address - Street 2:#2
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926
Mailing Address - Country:US
Mailing Address - Phone:509-962-2225
Mailing Address - Fax:509-962-2270
Practice Address - Street 1:109 S WATER ST
Practice Address - Street 2:#2
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926
Practice Address - Country:US
Practice Address - Phone:509-962-2225
Practice Address - Fax:509-962-2270
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor