Provider Demographics
NPI:1609108778
Name:GONSTEAD FAMILY CHIROPRACTIC OF FRANKLIN, LLC
Entity Type:Organization
Organization Name:GONSTEAD FAMILY CHIROPRACTIC OF FRANKLIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-437-2210
Mailing Address - Street 1:1261 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3034
Mailing Address - Country:US
Mailing Address - Phone:814-336-5420
Mailing Address - Fax:814-336-2898
Practice Address - Street 1:324 13TH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1367
Practice Address - Country:US
Practice Address - Phone:814-437-2210
Practice Address - Fax:814-437-2105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty