Provider Demographics
NPI:1316900350
Name:DACKOR, GARY PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:PAUL
Last Name:DACKOR
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 1:1701 N SANDHILLS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2337
Mailing Address - Country:US
Mailing Address - Phone:910-944-7889
Mailing Address - Fax:
Practice Address - Street 1:1701 N SANDHILLS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2337
Practice Address - Country:US
Practice Address - Phone:910-944-7889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908332Medicaid
NCT64305Medicare UPIN
NC8908332Medicaid