Provider Demographics
NPI:1992712152
Name:GINGRICH, BRUCE L (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:L
Last Name:GINGRICH
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 1:1317 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-9508
Mailing Address - Country:US
Mailing Address - Phone:717-838-6373
Mailing Address - Fax:717-838-7837
Practice Address - Street 1:1317 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-9508
Practice Address - Country:US
Practice Address - Phone:717-838-6373
Practice Address - Fax:717-838-7837
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006563L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGE792575OtherBLUE SHIELD
PAGE792575OtherBLUE SHIELD
PAU64599Medicare UPIN