Healthcare Provider Details

I. General information

NPI: 1679610703
Provider Name (Legal Business Name): GARY T. BERGSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 FREEPORT ROAD
SHARPSBURG PA
15215
US

IV. Provider business mailing address

701 FREEPORT ROAD
SHARPSBURG PA
15215
US

V. Phone/Fax

Practice location:
  • Phone: 412-781-4433
  • Fax: 412-781-9208
Mailing address:
  • Phone: 412-781-4433
  • Fax: 412-781-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC003337L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007699L
License Number StatePA

VIII. Authorized Official

Name: DR. GARY T BERGSTEIN
Title or Position: OWNER
Credential: DC
Phone: 412-781-4433