Provider Demographics
NPI:1427207307
Name:G & A ENTERPRISES PC
Entity Type:Organization
Organization Name:G & A ENTERPRISES PC
Other - Org Name:COMMUNITY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:570-992-1011
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:RT 209 REGENCY PLAZA STE 9
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-1221
Mailing Address - Country:US
Mailing Address - Phone:570-992-1011
Mailing Address - Fax:570-402-3534
Practice Address - Street 1:RT 209 REGENCY PLAZA
Practice Address - Street 2:STE 9
Practice Address - City:BRODHEADSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18322-1221
Practice Address - Country:US
Practice Address - Phone:570-992-1011
Practice Address - Fax:570-402-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001672673OtherHIGHMARK BS
PA1417921099OtherINDIVIDUAL NPI
PA088648TX8OtherMEDICARE INDIVIDUAL PETAN
PA088648TX8OtherMEDICARE INDIVIDUAL PETAN
PA088647Medicare PIN