Provider Demographics
NPI:1053331835
Name:BRUCE M GELCH DC PA
Entity Type:Organization
Organization Name:BRUCE M GELCH DC PA
Other - Org Name:PEMBROKE LAKES CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GELCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-441-7246
Mailing Address - Street 1:11270 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-4101
Mailing Address - Country:US
Mailing Address - Phone:954-441-7246
Mailing Address - Fax:954-441-7241
Practice Address - Street 1:11270 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-4101
Practice Address - Country:US
Practice Address - Phone:954-441-7246
Practice Address - Fax:954-441-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ0231BMedicare PIN