Provider Demographics
NPI:1992767891
Name:BARGER, GARY W (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:BARGER
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 1:806B PLAZA 66, HWY. 66 SOUTH
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284
Mailing Address - Country:US
Mailing Address - Phone:336-992-1111
Mailing Address - Fax:336-992-1111
Practice Address - Street 1:806B PLAZA 66, HWY. 66 SOUTH
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-992-1111
Practice Address - Fax:336-992-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890823XMedicaid
NC2449663Medicare ID - Type Unspecified
NC890823XMedicaid