Provider Demographics
NPI:1467422782
Name:GARD, EDMUND S (DC)
Entity Type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:S
Last Name:GARD
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 1:4081 GLADES PIKE
Mailing Address - Street 2:STE 100
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-444-1770
Mailing Address - Fax:814-444-0909
Practice Address - Street 1:4081 GLADES PIKE
Practice Address - Street 2:STE 100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-444-1770
Practice Address - Fax:814-444-0909
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001751L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA216980OtherUPMC
PA0008810940002Medicaid
PA035342OtherHIGHMARK BCBS
PA035342Medicare ID - Type Unspecified
T27237Medicare UPIN