Provider Demographics
NPI:1912072778
Name:GATEWAY CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:GATEWAY CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAUPT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-753-8080
Mailing Address - Street 1:7439 LINTON HALL RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-2977
Mailing Address - Country:US
Mailing Address - Phone:703-753-8080
Mailing Address - Fax:703-753-8011
Practice Address - Street 1:7439 NEW LINTON HALL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:703-753-8080
Practice Address - Fax:703-753-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06L03514111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA218176OtherANTHEM
VAC06929Medicare PIN