Provider Demographics
NPI:1124076369
Name:KARNES, GARY SCOTT (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:KARNES
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 1:1716 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1148
Mailing Address - Country:US
Mailing Address - Phone:618-997-2112
Mailing Address - Fax:618-997-2112
Practice Address - Street 1:1716 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1148
Practice Address - Country:US
Practice Address - Phone:618-997-2112
Practice Address - Fax:618-997-2112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL971960Medicare ID - Type Unspecified
ILU20466Medicare UPIN