MEDICARE: GKDC INC.

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	X009737	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	XVW791	OTHER	NY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	652644	OTHER	NM	ACN
2	P2981383	OTHER	NY	OXFORD
3	X5V43	OTHER	NY	BLUE CROSS BLUE SHIELD
5	5897815	OTHER	NY	GHI

General Provider Information

NPI Number	:	1851464408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GKDC INC.

Provider Business Mailing Address
First Line	:	PO BOX 611
Second Line	:
City	:	HARRISON
State	:	NY
Zip	:	10528-0611
Country	:	US
Telephone Number	:	914-698-9283
Fax Number	:	914-698-9436

Provider Business Practice Location Address
First Line	:	1600 HARRISON AVE
Second Line	:	SUITE 104
City	:	MAMARONECK
State	:	NY
Zip	:	10543-3145
Country	:	US
Telephone Number	:	914-698-9283
Fax Number	:	914-698-9436

Authorized Official
Title or Position	:	OWNER, PRESIDENT
Name	:	DR. GLENN KRIEGER
Credential	:	D.C.
Telephone Number	:	914-698-9283

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/15/2011

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Directions to “GKDC INC. ” Practice Location

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