Provider Demographics
NPI:1194068163
Name:RESHAMWALA, GAURAV MAHENDRA (DC)
Entity type:Individual
Prefix:DR
First Name:GAURAV
Middle Name:MAHENDRA
Last Name:RESHAMWALA
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 1:11900 PALM BAY CT
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-2052
Mailing Address - Country:US
Mailing Address - Phone:727-267-1618
Mailing Address - Fax:
Practice Address - Street 1:11900 PALM BAY CT
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2052
Practice Address - Country:US
Practice Address - Phone:727-267-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10863111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor