=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548445414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARRY L DULGAR PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 02/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 131 S OLD DIXIE HWY
-----------------------------------------------------
City | LADY LAKE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32159-4351
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-753-1845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1338
-----------------------------------------------------
City | LADY LAKE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32158-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-753-1845
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | GARRY L. DULGAR
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 352-753-1845
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------