Provider Demographics
NPI:1487788287
Name:ROTUNDA, GREGORY V (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:V
Last Name:ROTUNDA
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 1:258 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053-9313
Mailing Address - Country:US
Mailing Address - Phone:824-482-1193
Mailing Address - Fax:
Practice Address - Street 1:200 RENAISSANCE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5682
Practice Address - Country:US
Practice Address - Phone:724-283-4800
Practice Address - Fax:724-283-1358
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 001610-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA179573Medicare ID - Type Unspecified
PAT55074Medicare UPIN