Provider Demographics
NPI:1003994435
Name:CHRISTIANA, GERARD CARL (DC)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:CARL
Last Name:CHRISTIANA
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 1:85 PONDFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-961-0066
Mailing Address - Fax:914-961-8238
Practice Address - Street 1:85 PONDFIELD ROAD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-961-0066
Practice Address - Fax:914-961-8238
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0005411111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X1K681Medicare ID - Type Unspecified
U83408Medicare UPIN