Provider Demographics
NPI:1285780270
Name:EYRE, GARY J (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:EYRE
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 1:1870 JUDSON LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4004
Mailing Address - Country:US
Mailing Address - Phone:707-527-7463
Mailing Address - Fax:707-527-7476
Practice Address - Street 1:1870 JUDSON LANE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4004
Practice Address - Country:US
Practice Address - Phone:707-527-7463
Practice Address - Fax:707-527-7476
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC10413111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0104130Medicaid
CADC0104130Medicaid
CADC0104130Medicare ID - Type Unspecified