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NPI Code Detail

MEDICARE: DR. GARY BRYCE GAMACHE DC FIAMA DIPL AC

MEDICARE:  DR. GARY BRYCE GAMACHE  DC FIAMA DIPL AC
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
1111N00000XChiropractor572SD
2171100000XAcupuncturist572SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10085088OTHERSDWELLMARK BCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104826866
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY BRYCE GAMACHE DC FIAMA DIPL AC
Provider Business Mailing Address
First Line : 2720 W MAIN ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-8128
Country : US
Telephone Number : 605-342-4333
Fax Number : 605-348-6420
Provider Business Practice Location Address
First Line : 2720 W MAIN ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-8128
Country : US
Telephone Number : 605-342-4333
Fax Number : 605-348-6420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 11/06/2007

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