Provider Demographics
NPI:1013076876
Name:SPANIER, GARY (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:SPANIER
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 1:2802 N 46TH AVE APT B-624
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2927
Mailing Address - Country:US
Mailing Address - Phone:954-885-5656
Mailing Address - Fax:954-963-3434
Practice Address - Street 1:600 N HIATUS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5207
Practice Address - Country:US
Practice Address - Phone:954-885-5656
Practice Address - Fax:954-237-4860
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7454111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU92195Medicare UPIN
FL55842Medicare ID - Type Unspecified