Provider Demographics
NPI:1902045057
Name:SINES, GARY (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:SINES
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 1:305 E BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9306
Mailing Address - Country:US
Mailing Address - Phone:573-657-8300
Mailing Address - Fax:
Practice Address - Street 1:305 E BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-9306
Practice Address - Country:US
Practice Address - Phone:573-657-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004174111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor