Provider Demographics
NPI:1457577041
Name:BANEY, GARY L (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:BANEY
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 1:7566 WOODBURY PIKE
Mailing Address - Street 2:PO BOX 252
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-0252
Mailing Address - Country:US
Mailing Address - Phone:814-224-4511
Mailing Address - Fax:814-224-2529
Practice Address - Street 1:7566 WOODBURY PIKE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-0252
Practice Address - Country:US
Practice Address - Phone:814-224-4511
Practice Address - Fax:814-224-2529
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001500L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006239660001Medicaid
PA350409030OtherRAILROAD MEDICARE
PA0006239660001Medicaid
PA157441Medicare ID - Type UnspecifiedPROVIDER NUMBER