Provider Demographics
NPI:1649381799
Name:RISA L. GILDINER, D.C., P.C.
Entity type:Organization
Organization Name:RISA L. GILDINER, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RISA
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:TAU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:267-337-0369
Mailing Address - Street 1:1431 KNIGHTSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1446
Mailing Address - Country:US
Mailing Address - Phone:267-337-0369
Mailing Address - Fax:
Practice Address - Street 1:1431 KNIGHTSBRIDGE DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1446
Practice Address - Country:US
Practice Address - Phone:267-337-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-007189-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU91155Medicare UPIN
PA059870 QTFMedicare ID - Type UnspecifiedINDIVIDUAL ID
PA059860 QTFMedicare ID - Type UnspecifiedGROUP ID