MEDICARE: G L PAGENKOPF CO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC002428L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0662096	OTHER	PA	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	714797	OTHER	PA	HIGHMARK
5	104767	OTHER	PA	HIGHMARK
6	4644065	OTHER	PA	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	6667738	OTHER	PA	CIGNA
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	210837	OTHER	PA	UPMC

General Provider Information

NPI Number	:	1073610432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G L PAGENKOPF CO PA

Provider Business Mailing Address
First Line	:	181 LEITH WALK EXT
Second Line	:
City	:	CONNAUT
State	:	OH
Zip	:	44030
Country	:	US
Telephone Number	:	440-593-2078
Fax Number	:

Provider Business Practice Location Address
First Line	:	14603 RIDGE ROAD
Second Line	:
City	:	WEST SPRINGFIELD
State	:	PA
Zip	:	16443
Country	:	US
Telephone Number	:	814-922-3800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY L PAGENKOPF
Credential	:	DC
Telephone Number	:	814-922-3800

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “G L PAGENKOPF CO PA ” Practice Location

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