Provider Demographics
NPI:1871660175
Name:GABRIEL CHIROPRACTIC CENTER, P.C.
Entity Type:Organization
Organization Name:GABRIEL CHIROPRACTIC CENTER, P.C.
Other - Org Name:KEYSTONE CHIROPRACTIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-343-5949
Mailing Address - Street 1:1138 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1241
Mailing Address - Country:US
Mailing Address - Phone:570-343-5949
Mailing Address - Fax:570-343-2564
Practice Address - Street 1:1138 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1241
Practice Address - Country:US
Practice Address - Phone:570-343-5949
Practice Address - Fax:570-343-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003238-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08279Medicare UPIN
PA031809Medicare ID - Type Unspecified