Provider Demographics
NPI:1669464061
Name:GARY J RADER DC PC
Entity Type:Organization
Organization Name:GARY J RADER DC PC
Other - Org Name:RADER CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT(CHIROPRACTIC PHYSICIAN)
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-377-6927
Mailing Address - Street 1:95 ARMORY RD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1702
Mailing Address - Country:US
Mailing Address - Phone:203-377-6927
Mailing Address - Fax:203-381-0606
Practice Address - Street 1:95 ARMORY RD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1702
Practice Address - Country:US
Practice Address - Phone:203-377-6927
Practice Address - Fax:203-381-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03858Medicare PIN