Healthcare Provider Details

I. General information

NPI: 1184602799
Provider Name (Legal Business Name): GARY WAYNE MCKEEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 W VANDALIA RD
GREENSBORO NC
27407-7617
US

IV. Provider business mailing address

2007 W VANDALIA RD
GREENSBORO NC
27407-7617
US

V. Phone/Fax

Practice location:
  • Phone: 336-855-6316
  • Fax: 336-854-1843
Mailing address:
  • Phone: 336-855-6316
  • Fax: 336-854-1843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number1107
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: