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General NPI Number Information
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NPI Number | 1467739334
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Entity Type | Organization
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Legal Business Name | GONSTEAD FAMILY CHIROPRACTIC OF ERIE, P.C.
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 2129 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4743
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Country | US
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Telephone | 814-459-6940
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Fax | 814-459-0211
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Provider Business Mailing Address
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Address Line | 2129 W 8TH ST
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City | ERIE
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State | PA
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Zip | 16505-4743
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Country | US
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Telephone | 814-459-6940
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Fax | 814-459-0211
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BRADLEY JOSEPH MEALY
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Credential | D.C.
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Telephone | 814-459-6940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC010500
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License Number State | PA
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