Healthcare Provider Details

I. General information

NPI: 1750494043
Provider Name (Legal Business Name): GARY E HARNEY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 1ST AVE SE SUITE D
CEDAR RAPIDS IA
52402-5332
US

IV. Provider business mailing address

1935 1ST AVE SE SUITE D
CEDAR RAPIDS IA
52402-5332
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-3350
  • Fax: 319-365-1211
Mailing address:
  • Phone: 319-362-3350
  • Fax: 319-365-1211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberAO5723
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1111278
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: