Provider Demographics
NPI:1992859680
Name:STEPHENS, GARY ERNEST (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ERNEST
Last Name:STEPHENS
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 1:3235 SW 34TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7502
Mailing Address - Country:US
Mailing Address - Phone:352-622-4555
Mailing Address - Fax:352-861-4577
Practice Address - Street 1:3235 SW 34TH ST STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7502
Practice Address - Country:US
Practice Address - Phone:352-622-4555
Practice Address - Fax:352-861-4577
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8271111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL043625462OtherTAX ID
FL70888ZOtherLEGACY #
FLU91953Medicare UPIN