Provider Demographics
NPI:1922184548
Name:GASDORF FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GASDORF FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GASDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-665-3533
Mailing Address - Street 1:1960 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-8639
Mailing Address - Country:US
Mailing Address - Phone:260-665-3533
Mailing Address - Fax:260-665-3533
Practice Address - Street 1:1960 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-8639
Practice Address - Country:US
Practice Address - Phone:260-665-3533
Practice Address - Fax:260-665-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200442340AMedicaid
IN200442340AMedicaid
IN94836Medicare UPIN