Provider Demographics
NPI:1922165729
Name:SCHULZ, GARY THOMAS (DC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:THOMAS
Last Name:SCHULZ
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 1:10458 HILLTOP PLAZA WAY
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-5223
Mailing Address - Country:US
Mailing Address - Phone:540-295-5369
Mailing Address - Fax:540-373-1402
Practice Address - Street 1:10458 HILLTOP PLAZA WAY
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-2100
Practice Address - Country:US
Practice Address - Phone:540-295-5369
Practice Address - Fax:540-373-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541806211OtherTAX ID
VA060890Medicare UPIN
VA350000739Medicare ID - Type UnspecifiedMEDICARE