Provider Demographics
NPI:1649319187
Name:CGC MANAGEMENT CORPORATION
Entity type:Organization
Organization Name:CGC MANAGEMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:CIANCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-631-1595
Mailing Address - Street 1:611 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-3702
Mailing Address - Country:US
Mailing Address - Phone:215-631-1595
Mailing Address - Fax:215-631-1596
Practice Address - Street 1:611 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-3702
Practice Address - Country:US
Practice Address - Phone:215-631-1595
Practice Address - Fax:215-631-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005306-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1432995OtherPA BS GROUP NUMBER
PA2119560000OtherKEYSTONE HMO GRP ID
PA2119560000OtherPERSONAL CHOICE GROUP ID
PA2119560000OtherAMERIHEALTH GRP ID
PA2119560000OtherKEYSTONE HMO GRP ID