Provider Demographics
NPI:1104075670
Name:GREGG A. GOHEN
Entity type:Organization
Organization Name:GREGG A. GOHEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:215-918-1500
Mailing Address - Street 1:PO BOX 78
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18933-0078
Mailing Address - Country:US
Mailing Address - Phone:215-918-1500
Mailing Address - Fax:215-918-1503
Practice Address - Street 1:1432 EASTON RD
Practice Address - Street 2:SUITE 5B
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2852
Practice Address - Country:US
Practice Address - Phone:215-918-1500
Practice Address - Fax:215-918-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC2987-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA188362Medicare PIN