Provider Demographics
NPI:1649225483
Name:AGASAR, GERALD J (DC)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:AGASAR
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 1:4 TERRY DR STE 12
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1882
Mailing Address - Country:US
Mailing Address - Phone:215-550-6502
Mailing Address - Fax:215-968-2030
Practice Address - Street 1:4 TERRY DR STE 12
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940
Practice Address - Country:US
Practice Address - Phone:215-550-6502
Practice Address - Fax:215-968-2030
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-2055-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0780618Medicaid
PA143916Medicare ID - Type Unspecified
PA0780618Medicaid