Provider Demographics
NPI:1316005010
Name:DRS GOLD AND VERNON CHIROPRACTIC PA
Entity Type:Organization
Organization Name:DRS GOLD AND VERNON CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MEYER
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-998-1424
Mailing Address - Street 1:5175 W WOODMILL DRIVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4067
Mailing Address - Country:US
Mailing Address - Phone:302-998-1424
Mailing Address - Fax:302-998-1526
Practice Address - Street 1:5175 W WOODMILL DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4067
Practice Address - Country:US
Practice Address - Phone:302-998-1424
Practice Address - Fax:302-998-1526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF1-0000208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEGO1658Medicare PIN