Provider Demographics
NPI:1093775348
Name:KAISER, GORDON WILLIAM III (DC)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:WILLIAM
Last Name:KAISER
Suffix:III
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-0008
Mailing Address - Country:US
Mailing Address - Phone:717-485-9000
Mailing Address - Fax:717-485-9000
Practice Address - Street 1:113 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1017
Practice Address - Country:US
Practice Address - Phone:717-485-9000
Practice Address - Fax:717-485-9000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005461L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T20511Medicare UPIN
PAKA677627Medicare ID - Type UnspecifiedBLUE SHIELD