Provider Demographics
NPI:1528027570
Name:GORLESKY, JACK (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:GORLESKY
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 1:301 S WHITE ST
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-2916
Mailing Address - Country:US
Mailing Address - Phone:919-556-1033
Mailing Address - Fax:919-556-1034
Practice Address - Street 1:301 S WHITE ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-2916
Practice Address - Country:US
Practice Address - Phone:919-556-1033
Practice Address - Fax:919-556-1034
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1030111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08452OtherBC/BS
NC2456730Medicare ID - Type Unspecified