Provider Demographics
NPI:1013901438
Name:ELLIOTT, GARY EDWARD (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EDWARD
Last Name:ELLIOTT
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 1:448 SIDNEY BAKER S
Mailing Address - Street 2:SUITE #101
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5915
Mailing Address - Country:US
Mailing Address - Phone:830-896-7788
Mailing Address - Fax:830-896-7887
Practice Address - Street 1:448 SIDNEY BAKER S
Practice Address - Street 2:SUITE #101
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5915
Practice Address - Country:US
Practice Address - Phone:830-896-7788
Practice Address - Fax:830-896-7887
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP13156Medicare UPIN
TX600825Medicare PIN