Provider Demographics
NPI:1063555134
Name:GONGAWARE, KRIS DUANE (DC)
Entity type:Individual
Prefix:DR
First Name:KRIS
Middle Name:DUANE
Last Name:GONGAWARE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 SANDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7784
Mailing Address - Country:US
Mailing Address - Phone:724-316-0717
Mailing Address - Fax:
Practice Address - Street 1:5499 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9675
Practice Address - Country:US
Practice Address - Phone:724-316-0717
Practice Address - Fax:724-443-6963
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-006022111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor