MEDICARE: DR. GARY WILLIAM SPERO D.C.

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	X004188-1	NY

General Provider Information

NPI Number	:	1235249434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WILLIAM SPERO D.C.

Provider Business Mailing Address
First Line	:	10 GRAND CENTRAL AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-3724
Country	:	US
Telephone Number	:	631-691-1070
Fax Number	:	631-691-1073

Provider Business Practice Location Address
First Line	:	10 GRAND CENTRAL AVE
Second Line	:
City	:	AMITYVILLE
State	:	NY
Zip	:	11701-3724
Country	:	US
Telephone Number	:	631-691-1070
Fax Number	:	631-691-1073

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/24/2011

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