Provider Demographics
NPI:1902934193
Name:NOLAN, GARY WADE (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:WADE
Last Name:NOLAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3315 ALMADEN EXPY
Mailing Address - Street 2:STE 29
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:408-384-1519
Mailing Address - Fax:408-384-1519
Practice Address - Street 1:3315 ALMADEN EXPY
Practice Address - Street 2:STE 29
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-1557
Practice Address - Country:US
Practice Address - Phone:408-384-1519
Practice Address - Fax:408-604-0166
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC 30783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor