Provider Demographics
NPI:1952301558
Name:DENNIS, GARY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALLEN
Last Name:DENNIS
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 1:10831 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4701
Mailing Address - Country:US
Mailing Address - Phone:703-273-7733
Mailing Address - Fax:703-385-9693
Practice Address - Street 1:10831 MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4701
Practice Address - Country:US
Practice Address - Phone:703-273-7733
Practice Address - Fax:703-385-9693
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000P75F46Medicare PIN