Provider Demographics
NPI:1215067566
Name:BLAIR, GARY Q (DC)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:Q
Last Name:BLAIR
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 1:1185 ARTHUR STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:541-343-7076
Mailing Address - Fax:541-683-0891
Practice Address - Street 1:1185 ARTHUR STREET
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:541-343-7076
Practice Address - Fax:541-683-0891
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1859111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T01528Medicare UPIN
ORR118558Medicare ID - Type Unspecified