Provider Demographics
NPI:1801971429
Name:WARNER, GARRY A (DC)
Entity type:Individual
Prefix:DR
First Name:GARRY
Middle Name:A
Last Name:WARNER
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 1:10815 W JEWELL AVE STE P
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-6268
Mailing Address - Country:US
Mailing Address - Phone:303-980-1378
Mailing Address - Fax:303-980-1379
Practice Address - Street 1:10815 W JEWELL AVE STE P
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6268
Practice Address - Country:US
Practice Address - Phone:303-980-1378
Practice Address - Fax:303-980-1379
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO400077OtherPTAN
COC27263Medicare PIN