Provider Demographics
NPI:1285713388
Name:GUMBERICH, GREGORY RAYMOND (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:RAYMOND
Last Name:GUMBERICH
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 1:6426 LAKE WORTH ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3008
Mailing Address - Country:US
Mailing Address - Phone:561-964-1600
Mailing Address - Fax:561-964-5404
Practice Address - Street 1:6426 LAKE WORTH ROAD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-3008
Practice Address - Country:US
Practice Address - Phone:561-964-1600
Practice Address - Fax:561-964-5404
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2848111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5653Medicare ID - Type Unspecified