Provider Demographics
NPI:1467739334
Name:GONSTEAD FAMILY CHIROPRACTIC OF ERIE, P.C.
Entity Type:Organization
Organization Name:GONSTEAD FAMILY CHIROPRACTIC OF ERIE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MEALY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-459-6940
Mailing Address - Street 1:2129 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4743
Mailing Address - Country:US
Mailing Address - Phone:814-459-6940
Mailing Address - Fax:814-459-0211
Practice Address - Street 1:2129 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4743
Practice Address - Country:US
Practice Address - Phone:814-459-6940
Practice Address - Fax:814-459-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty