Provider Demographics
NPI:1013987163
Name:DILLON, GARY DUAYNE (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DUAYNE
Last Name:DILLON
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 1:5936 SWANSON DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-7205
Mailing Address - Country:US
Mailing Address - Phone:606-929-9667
Mailing Address - Fax:606-929-9670
Practice Address - Street 1:5936 SWANSON DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-7205
Practice Address - Country:US
Practice Address - Phone:606-929-9667
Practice Address - Fax:606-929-9670
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2556336Medicaid
KY85002335Medicaid
KY000000244994OtherBC BS ID #
WV3810002417Medicaid
KY0007160402OtherAETNA GROUP ID #
KY645626OtherACN GROUP #
KYU92575Medicare UPIN
KY7367Medicare PIN
KY0736701Medicare PIN