Provider Demographics
NPI:1336363423
Name:FIKE, GARY (DC CMT CERTIFIED MAS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:FIKE
Suffix:
Gender:M
Credentials:DC CMT CERTIFIED MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 TIMBERBROOK TR
Mailing Address - Street 2:
Mailing Address - City:FT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9745
Mailing Address - Country:US
Mailing Address - Phone:260-637-8016
Mailing Address - Fax:
Practice Address - Street 1:2309 TIMBERBROOK TR
Practice Address - Street 2:
Practice Address - City:FT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9745
Practice Address - Country:US
Practice Address - Phone:260-637-8016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000656A111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist