MEDICARE: GARY WARREN D.C. LTD

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	B00508	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VDC508A	OTHER	NV	MEDICARE PTAN

General Provider Information

NPI Number	:	1669761797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY WARREN D.C. LTD

Provider Business Mailing Address
First Line	:	3045 LAKESIDE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4502
Country	:	US
Telephone Number	:	775-828-3456
Fax Number	:	775-828-5433

Provider Business Practice Location Address
First Line	:	3045 LAKESIDE DR
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89509-4502
Country	:	US
Telephone Number	:	775-828-3456
Fax Number	:	775-828-5433

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. GARY LYNN WARREN
Credential	:	D.C.
Telephone Number	:	775-828-3456

Provider Enumeration Date	:	03/29/2011
Last Update Date	:	03/29/2011

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