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General NPI Number Information
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NPI Number | 1710389663
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Entity Type | Organization
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Legal Business Name | GATEWAY CHIROPRACTIC OF HANOVER, LLC
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 10 BUCK RD SUITE 8
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City | HANOVER
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State | NH
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Zip | 03755-2700
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Country | US
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Telephone | 603-667-0095
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Fax |
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Provider Business Mailing Address
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Address Line | 10 BUCK RD SUITE 8
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City | HANOVER
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State | NH
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Zip | 03755-2700
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Country | US
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Telephone | 603-667-0095
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. MATTHEW ALBERT STRALKA
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Credential | DC
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Telephone | 603-667-0095
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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 | 929
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License Number State | NH
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