Provider Demographics
NPI:1427334655
Name:GARY W PLUMMER
Entity type:Organization
Organization Name:GARY W PLUMMER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MCC
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-563-4472
Mailing Address - Street 1:2650 S MCCALL RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224-6400
Mailing Address - Country:US
Mailing Address - Phone:941-460-0287
Mailing Address - Fax:941-473-8989
Practice Address - Street 1:2650 S MCCALL RD
Practice Address - Street 2:SUITE D
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-6400
Practice Address - Country:US
Practice Address - Phone:941-460-0287
Practice Address - Fax:941-473-8989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6615380001Medicare NSC