Provider Demographics
NPI:1255443560
Name:UNFERTH, GARY P (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:UNFERTH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 BRIG LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-2824
Mailing Address - Country:US
Mailing Address - Phone:865-637-8395
Mailing Address - Fax:865-637-8395
Practice Address - Street 1:5207 BRIG LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37914-2824
Practice Address - Country:US
Practice Address - Phone:865-637-8395
Practice Address - Fax:865-637-8395
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC000222111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3673717Medicare PIN
TNU02580Medicare UPIN