Provider Demographics
NPI:1891824231
Name:GARNESS, GAYLE LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:LYNN
Last Name:GARNESS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2344
Mailing Address - Country:US
Mailing Address - Phone:218-724-6008
Mailing Address - Fax:218-724-4499
Practice Address - Street 1:1410 KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2344
Practice Address - Country:US
Practice Address - Phone:218-724-6008
Practice Address - Fax:218-724-4499
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNV17944Medicare UPIN