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NPI Code Detail

MEDICARE: DR GARY R DETWEILER PC

MEDICARE: DR GARY R DETWEILER PC
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
1111N00000XChiropractor0104000256VA

General Provider Information

NPI Number : 1679868038
Entity Type Code : Organization
Provider Name (Legal Business Name) : DR GARY R DETWEILER PC
Provider Business Mailing Address
First Line : 3529 VIRGINIA BEACH BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-4421
Country : US
Telephone Number : 757-463-0050
Fax Number : 757-357-7232
Provider Business Practice Location Address
First Line : 3529 VIRGINIA BEACH BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23452-4421
Country : US
Telephone Number : 757-463-0050
Fax Number : 757-357-7232
Authorized Official
Title or Position : OWNER/DOCTOR
Name : DR. GARY R DETWEILER
Credential : PC
Telephone Number : 757-463-0050
Provider Enumeration Date : 06/14/2011
Last Update Date : 06/14/2011

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