Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 2348 | NC |
NPI | 1003830373 |
---|---|
Provider Name | Gary Walicki |
First Address | Asheville, NC 28806 |
Second Address | Asheville, NC 28806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
890840J | (05) | NC |
U80780 | (02) | NC |