Provider Demographics
NPI:1902015944
Name:MCGOWAN, GARY VERGIL (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:VERGIL
Last Name:MCGOWAN
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:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-0256
Mailing Address - Country:US
Mailing Address - Phone:763-972-2404
Mailing Address - Fax:
Practice Address - Street 1:210 82ND ST SE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MN
Practice Address - Zip Code:55363-8005
Practice Address - Country:US
Practice Address - Phone:763-972-2404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor