Provider Demographics
NPI:1548445414
Name:GARRY L DULGAR PA
Entity type:Organization
Organization Name:GARRY L DULGAR PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DULGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-753-1845
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32158-1338
Mailing Address - Country:US
Mailing Address - Phone:352-753-1845
Mailing Address - Fax:
Practice Address - Street 1:131 S OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-4351
Practice Address - Country:US
Practice Address - Phone:352-753-1845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty