Provider Demographics
NPI:1992816672
Name:GARST, GARY BAUER (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:BAUER
Last Name:GARST
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 1:3609 BRANDON AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1525
Mailing Address - Country:US
Mailing Address - Phone:540-297-3440
Mailing Address - Fax:540-297-9313
Practice Address - Street 1:3609 BRANDON AVE SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1525
Practice Address - Country:US
Practice Address - Phone:540-297-3440
Practice Address - Fax:540-297-9313
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000405111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADE3294OtherRAILROAD MEDICARE
VA142884OtherANTHEM
250139OtherSOUTHERN HEALTH
5897389OtherGHI
VA1992816672Medicaid
4632907OtherAETNA
2089536OtherCIGNA
2089536OtherCIGNA
VA1992816672Medicaid