Healthcare Provider Details

I. General information

NPI: 1881992360
Provider Name (Legal Business Name): JAMES P. GANO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 INDIAN BOUNDARY RD SUITE 4
CHESTERTON IN
46304-1586
US

IV. Provider business mailing address

761 INDIAN BOUNDARY RD SUITE 4
CHESTERTON IN
46304-1586
US

V. Phone/Fax

Practice location:
  • Phone: 219-728-6649
  • Fax: 888-741-5926
Mailing address:
  • Phone: 219-728-6649
  • Fax: 888-741-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002566A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: