Provider Demographics
NPI:1700811510
Name:MCDOWELL, GARY MICHAEL (DC, CCSP, QME)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DC, CCSP, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3855 AVOCADO BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7382
Mailing Address - Country:US
Mailing Address - Phone:619-670-7700
Mailing Address - Fax:619-670-3540
Practice Address - Street 1:3855 AVOCADO BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7382
Practice Address - Country:US
Practice Address - Phone:619-670-7700
Practice Address - Fax:619-670-3540
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC19534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC19534Medicare ID - Type UnspecifiedMEDICARE