Provider Demographics
NPI:1932293453
Name:GARRIS, GENE ALLEN JR (DC)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:ALLEN
Last Name:GARRIS
Suffix:JR
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 61106
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260
Mailing Address - Country:US
Mailing Address - Phone:803-466-5338
Mailing Address - Fax:
Practice Address - Street 1:2300 DEVINE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-2404
Practice Address - Country:US
Practice Address - Phone:803-466-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2480111N00000X
GA6699111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU889107300Medicare UPIN