MEDICARE: DR. GARY DUAYNE DILLON DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4584	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000244994	OTHER	KY	BC BS ID #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0007160402	OTHER	KY	AETNA GROUP ID #
6	645626	OTHER	KY	ACN GROUP #

General Provider Information

NPI Number	:	1013987163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DUAYNE DILLON DC

Provider Business Mailing Address
First Line	:	5936 SWANSON DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-7205
Country	:	US
Telephone Number	:	606-929-9667
Fax Number	:	606-929-9670

Provider Business Practice Location Address
First Line	:	5936 SWANSON DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41102-7205
Country	:	US
Telephone Number	:	606-929-9667
Fax Number	:	606-929-9670

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/20/2010

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