MEDICARE: DR. GARY M CHENEY DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	B00353	NV

General Provider Information

NPI Number	:	1053485458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY M CHENEY DC

Provider Business Mailing Address
First Line	:	1605 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3312
Country	:	US
Telephone Number	:	702-382-0211
Fax Number	:	702-382-3994

Provider Business Practice Location Address
First Line	:	1605 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3312
Country	:	US
Telephone Number	:	702-382-0211
Fax Number	:	702-382-3994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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