Provider Demographics
NPI:1760654545
Name:CHIROPRACTIC OFFICES OF CRAIG P GINDELE DC PA
Entity Type:Organization
Organization Name:CHIROPRACTIC OFFICES OF CRAIG P GINDELE DC PA
Other - Org Name:CRAIG P GINDELE DC PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GINDELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-997-8200
Mailing Address - Street 1:8190 LITTLETON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903
Mailing Address - Country:US
Mailing Address - Phone:239-997-8200
Mailing Address - Fax:239-997-8332
Practice Address - Street 1:8190 LITTLETON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:N FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903
Practice Address - Country:US
Practice Address - Phone:239-997-8200
Practice Address - Fax:239-997-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0003494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380082200Medicaid
FLT55875Medicare UPIN
FLK8518Medicare PIN