Provider Demographics
NPI:1497734032
Name:KEPPEL, GREGORY S (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:KEPPEL
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 1:201 MAIN ST.
Mailing Address - Street 2:PO BOX 157
Mailing Address - City:STOCKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18083
Mailing Address - Country:US
Mailing Address - Phone:610-746-3000
Mailing Address - Fax:610-746-3000
Practice Address - Street 1:201 MAIN ST.
Practice Address - Street 2:
Practice Address - City:STOCKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18083
Practice Address - Country:US
Practice Address - Phone:610-746-3000
Practice Address - Fax:610-746-3000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC4420L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003446OtherHIGHMARK BLUE SHIELD
PA50004042OtherCAPITAL BLUE CROSS
PA11357835OtherCAQH
PA1034997OtherASHN
PAP3385922OtherOXFORD
PA50004042OtherCAPITAL BLUE CROSS