Provider Demographics
NPI:1053332205
Name:NICHOLAS J GRESOCK DC PC
Entity Type:Organization
Organization Name:NICHOLAS J GRESOCK DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRESOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-856-1100
Mailing Address - Street 1:4039 MONROEVILLE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2505
Mailing Address - Country:US
Mailing Address - Phone:412-856-1100
Mailing Address - Fax:412-856-0864
Practice Address - Street 1:4039 MONROEVILLE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2505
Practice Address - Country:US
Practice Address - Phone:412-856-1100
Practice Address - Fax:412-856-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1598414OtherHIGHMARK