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General NPI Number Information
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NPI Number | 1265750665
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Entity Type | Organization
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Legal Business Name | DR CARL GAUDIO DC LLC
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Dates
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Enumeration Date | 05/10/2010
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Last Update Date | 05/10/2010
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Provider Practice Location Address
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Address Line | 343 E MAIDEN ST
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City | WASHINGTON
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State | PA
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Zip | 15301-5107
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Country | US
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Telephone | 724-222-5777
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Fax | 724-222-5779
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Provider Business Mailing Address
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Address Line | 214 COUNTRY DR
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City | BELLE VERNON
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State | PA
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Zip | 15012-3606
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Country | US
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Telephone | 724-309-4346
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Fax | 724-222-5779
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. A CARL GAUDIO II
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Credential |
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Telephone | 724-309-4346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | DC005644L
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License Number State | PA
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