MEDICARE: DR. GARY LEE HOPKINS 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	08001115A	IN

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

General Provider Information

NPI Number	:	1437113594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY LEE HOPKINS D.C.

Provider Business Mailing Address
First Line	:	5800 FAIRFIELD AVE
Second Line	:	SUITE 112
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3400
Country	:	US
Telephone Number	:	260-456-4074
Fax Number	:	260-456-4074

Provider Business Practice Location Address
First Line	:	5800 FAIRFIELD AVE
Second Line	:	SUITE 112
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-3400
Country	:	US
Telephone Number	:	260-456-4074
Fax Number	:	260-456-4074

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	05/21/2008

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