Provider Demographics
NPI:1295854792
Name:GERBER FAMILY CHIROPRACTIC & WELLNES CENTER PLLC
Entity Type:Organization
Organization Name:GERBER FAMILY CHIROPRACTIC & WELLNES CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-793-5555
Mailing Address - Street 1:12 HAVILAND RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9720
Mailing Address - Country:US
Mailing Address - Phone:518-793-5555
Mailing Address - Fax:518-793-5551
Practice Address - Street 1:12 HAVILAND RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-9720
Practice Address - Country:US
Practice Address - Phone:518-793-5555
Practice Address - Fax:518-793-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011021-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty