Provider Demographics
NPI:1851464408
Name:GKDC INC.
Entity Type:Organization
Organization Name:GKDC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-698-9283
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-0611
Mailing Address - Country:US
Mailing Address - Phone:914-698-9283
Mailing Address - Fax:914-698-9436
Practice Address - Street 1:1600 HARRISON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3145
Practice Address - Country:US
Practice Address - Phone:914-698-9283
Practice Address - Fax:914-698-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM652644OtherACN
NYP2981383OtherOXFORD
NYX5V43OtherBLUE CROSS BLUE SHIELD
NYXVW791OtherMEDICARE PTAN
NY5897815OtherGHI