Provider Demographics
NPI:1558462804
Name:DUERMIT, GARY LOUIS (D C)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LOUIS
Last Name:DUERMIT
Suffix:
Gender:M
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2422 E FOSTER MAINEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:OH
Mailing Address - Zip Code:45152-8575
Mailing Address - Country:US
Mailing Address - Phone:513-543-1361
Mailing Address - Fax:
Practice Address - Street 1:25 E US HIGHWAY 22 AND 3
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-9626
Practice Address - Country:US
Practice Address - Phone:513-683-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3432111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2431176Medicaid
OH000000301627OtherANTHEM BC/BS
OH3432COtherHUMANA/CHOICECARE
OH659888OtherACN/UNITED HEALTHCARE
OH4122051Medicare ID - Type Unspecified
OH2431176Medicaid