1649210063 NPI number — GREG L. GILBERT, D.C. LLC

Table of content: (NPI 1649210063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649210063 NPI number — GREG L. GILBERT, D.C. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREG L. GILBERT, D.C. LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649210063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
329 FOREST GROVE RD
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
CORAOPOLIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15108-3709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-771-4233
Provider Business Mailing Address Fax Number:
412-771-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
329 FOREST GROVE RD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
CORAOPOLIS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15108-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-771-4233
Provider Business Practice Location Address Fax Number:
412-771-4234
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GILBERT
Authorized Official First Name:
GREG
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-771-4233

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC005566L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1010521670001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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