Provider Demographics
NPI:1801867429
Name:SPRUCH, GABOR (DC)
Entity Type:Individual
Prefix:
First Name:GABOR
Middle Name:
Last Name:SPRUCH
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 1:221 W COURT AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3529
Mailing Address - Country:US
Mailing Address - Phone:812-288-7000
Mailing Address - Fax:
Practice Address - Street 1:221 W COURT AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3529
Practice Address - Country:US
Practice Address - Phone:812-288-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001220A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100076330Medicaid
IN100076330Medicaid
IN162080Medicare ID - Type Unspecified