Provider Demographics
NPI:1417342841
Name:GURCIULLO, ANTHONY (DC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GURCIULLO
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 1:4432 ROSEBAY CT E
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-9573
Mailing Address - Country:US
Mailing Address - Phone:570-730-7311
Mailing Address - Fax:
Practice Address - Street 1:4432 ROSEBAY CT E
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-9573
Practice Address - Country:US
Practice Address - Phone:570-730-7311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007048L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA468428Medicare UPIN