Provider Demographics
NPI:1851832562
Name:GATZ, SAMUEL GARY (DC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:GARY
Last Name:GATZ
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 1:1001 N ROSE HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-9464
Mailing Address - Country:US
Mailing Address - Phone:316-440-4551
Mailing Address - Fax:
Practice Address - Street 1:1001 N ROSE HILL RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-9464
Practice Address - Country:US
Practice Address - Phone:316-440-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor