Provider Demographics
NPI:1093022410
Name:BEDESEM, GREGORY M (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:M
Last Name:BEDESEM
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 1:240 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:PA
Mailing Address - Zip Code:17501-1361
Mailing Address - Country:US
Mailing Address - Phone:717-859-1099
Mailing Address - Fax:717-859-1052
Practice Address - Street 1:240 N 7TH ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:PA
Practice Address - Zip Code:17501-1361
Practice Address - Country:US
Practice Address - Phone:717-859-1099
Practice Address - Fax:717-859-1052
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002899L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor