Provider Demographics
NPI:1669700985
Name:GORGO, RICHARD C JR (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:GORGO
Suffix:JR
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 1:49 WAGNER LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-4171
Mailing Address - Country:US
Mailing Address - Phone:610-880-4169
Mailing Address - Fax:484-712-5189
Practice Address - Street 1:819 N OCTORARA TRL
Practice Address - Street 2:
Practice Address - City:PARKESBURG
Practice Address - State:PA
Practice Address - Zip Code:19365-2114
Practice Address - Country:US
Practice Address - Phone:610-880-4169
Practice Address - Fax:484-712-5189
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-24
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02018111N00000X
PADC007027L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG00028Medicare UPIN