Provider Demographics
NPI:1649286584
Name:GUNZBURGER, GREGORY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:GUNZBURGER
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 1:29 MARTIN STREET
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895
Mailing Address - Country:US
Mailing Address - Phone:585-593-1600
Mailing Address - Fax:585-672-6146
Practice Address - Street 1:29 MARTIN STREET
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895
Practice Address - Country:US
Practice Address - Phone:585-593-1600
Practice Address - Fax:585-672-6146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY75640111N00000X
PA5526L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48943Medicare UPIN
NY11982BMedicare PIN