Healthcare Provider Details

I. General information

NPI: 1992816672
Provider Name (Legal Business Name): GARY BAUER GARST DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3609 BRANDON AVE SW
ROANOKE VA
24018-1525
US

IV. Provider business mailing address

3609 BRANDON AVE SW
ROANOKE VA
24018-1525
US

V. Phone/Fax

Practice location:
  • Phone: 540-297-3440
  • Fax: 540-297-9313
Mailing address:
  • Phone: 540-297-3440
  • Fax: 540-297-9313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number0104000405
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: