Provider Demographics
NPI:1215373857
Name:GAMBLE, PHILLIP ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ANDREW
Last Name:GAMBLE
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 1:511 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2152
Mailing Address - Country:US
Mailing Address - Phone:630-442-0057
Mailing Address - Fax:
Practice Address - Street 1:511 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2152
Practice Address - Country:US
Practice Address - Phone:630-442-0057
Practice Address - Fax:630-791-0861
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.012389111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor