Provider Demographics
NPI:1598924748
Name:GOLDEN GATE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GOLDEN GATE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCE
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CANCELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-455-4181
Mailing Address - Street 1:4981 GOLDEN GATE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-6972
Mailing Address - Country:US
Mailing Address - Phone:239-455-4181
Mailing Address - Fax:
Practice Address - Street 1:4981 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-6972
Practice Address - Country:US
Practice Address - Phone:239-455-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6788111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55160Medicare PIN