Provider Demographics
NPI:1770688442
Name:LAU, GARY T (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:LAU
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 1:2335 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-1620
Mailing Address - Country:US
Mailing Address - Phone:415-681-3883
Mailing Address - Fax:415-681-4570
Practice Address - Street 1:2335 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-1620
Practice Address - Country:US
Practice Address - Phone:415-681-3883
Practice Address - Fax:415-681-4570
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT05701Medicare UPIN
CADC0152830Medicare ID - Type Unspecified