Provider Demographics
NPI:1851394050
Name:BRIDGES, GARY DEAN (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:BRIDGES
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 1:1103 BUCKEYE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8120
Mailing Address - Country:US
Mailing Address - Phone:515-233-2225
Mailing Address - Fax:515-233-3774
Practice Address - Street 1:1103 BUCKEYE AVE STE 102
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8120
Practice Address - Country:US
Practice Address - Phone:515-233-2225
Practice Address - Fax:515-233-3774
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05924171100000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134254Medicaid
IA1134254Medicaid