Provider Demographics
NPI:1922109685
Name:SPEARS, GARY E (D C)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:SPEARS
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12189 W. 64TH AVE.,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-425-8730
Mailing Address - Fax:
Practice Address - Street 1:12189 W. 64TH AVE.,
Practice Address - Street 2:SUITE 102
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004
Practice Address - Country:US
Practice Address - Phone:303-425-8730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T60348Medicare UPIN