Provider Demographics
NPI:1861080897
Name:GANGEMI CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GANGEMI CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARMINE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GANGEMI
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:310-985-0903
Mailing Address - Street 1:369 W BLACKWELL ST STE 2
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07801-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:369 W BLACKWELL ST STE 2
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:310-985-0903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty