Organization
GKDC INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN KRIEGER D.C. (OWNER, PRESIDENT)
(914) 698-9283
Entity
Organization
Contact information
Practice address
1600 HARRISON AVE, SUITE 104, MAMARONECK, NY 10543-3145
(914) 698-9283
(914) 698-9436
Mailing address
PO BOX 611, HARRISON, NY 10528-0611
(914) 698-9283
(914) 698-9436
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X009737
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5897815
GHI
NY
01
—
652644
ACN
NM
01
—
P2981383
OXFORD
NY
01
—
X5V43
BLUE CROSS BLUE SHIELD
NY
01
—
XVW791
MEDICARE PTAN
NY
Enumeration date
11/15/2006
Last updated
09/15/2011
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