Provider Demographics
NPI:1356424790
Name:CARVER, GARY LEWIS (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEWIS
Last Name:CARVER
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 1:4409 STERLING AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-1854
Mailing Address - Country:US
Mailing Address - Phone:816-358-5100
Mailing Address - Fax:816-358-6565
Practice Address - Street 1:4409 STERLING AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64133-1854
Practice Address - Country:US
Practice Address - Phone:816-358-5100
Practice Address - Fax:816-358-6565
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3722111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
03274013OtherBLUE CROSS
03274013OtherBLUE CROSS
T73678Medicare UPIN