Provider Demographics
NPI:1639272743
Name:GITTINGER, GERALD BRIAN (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:BRIAN
Last Name:GITTINGER
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 1:675 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3810
Mailing Address - Country:US
Mailing Address - Phone:440-232-7070
Mailing Address - Fax:440-232-7071
Practice Address - Street 1:675 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3810
Practice Address - Country:US
Practice Address - Phone:440-232-7070
Practice Address - Fax:440-232-7071
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1403111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GI0619932Medicare ID - Type Unspecified
U17029Medicare UPIN