Provider Demographics
NPI:1700957909
Name:FLOCK, GAIL Y (D,C,)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:Y
Last Name:FLOCK
Suffix:
Gender:F
Credentials:D,C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W STEWART AVE
Mailing Address - Street 2:#101
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3600
Mailing Address - Country:US
Mailing Address - Phone:541-779-9650
Mailing Address - Fax:541-779-5315
Practice Address - Street 1:255 W STEWART AVE
Practice Address - Street 2:#101
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3600
Practice Address - Country:US
Practice Address - Phone:541-779-9650
Practice Address - Fax:541-779-5315
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27 3105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor