Provider Demographics
NPI:1699870436
Name:GASDORF, NATHANIEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:JOHN
Last Name:GASDORF
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 1:1960 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-8639
Mailing Address - Country:US
Mailing Address - Phone:260-665-3533
Mailing Address - Fax:260-665-3533
Practice Address - Street 1:1960 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-8639
Practice Address - Country:US
Practice Address - Phone:260-665-3533
Practice Address - Fax:260-665-3533
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0800206A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200442340AMedicaid
232940Medicare ID - Type Unspecified
U94836Medicare UPIN