Provider Demographics
NPI:1437459559
Name:GIFFORD CHIROPRACTIC & NEURODIAGNOSTIC CENTER, PA
Entity Type:Organization
Organization Name:GIFFORD CHIROPRACTIC & NEURODIAGNOSTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-455-3822
Mailing Address - Street 1:4930 GOLDEN GATE PKWY.
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116
Mailing Address - Country:US
Mailing Address - Phone:239-455-3822
Mailing Address - Fax:239-455-0891
Practice Address - Street 1:4930 GOLDEN GATE PKWY.
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116
Practice Address - Country:US
Practice Address - Phone:239-455-3822
Practice Address - Fax:239-455-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZCH6154111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3804526-00Medicaid
FLU10-200Medicare UPIN
FL22578Medicare PIN