Provider Demographics
NPI:1386187250
Name:GRETZ CHIROPRACTIC CENTERS
Entity Type:Organization
Organization Name:GRETZ CHIROPRACTIC CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-716-3955
Mailing Address - Street 1:601 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9523
Mailing Address - Country:US
Mailing Address - Phone:412-716-3955
Mailing Address - Fax:
Practice Address - Street 1:300 CEDAR HILL DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2529
Practice Address - Country:US
Practice Address - Phone:724-743-4500
Practice Address - Fax:724-743-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-28
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004148L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA714675N2JMedicare UPIN
PAU29376Medicare UPIN