Provider Demographics
NPI:1316934987
Name:MACHACECK, GILBERT A (DC DABCO)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:A
Last Name:MACHACECK
Suffix:
Gender:M
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 58TH STREET N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710
Mailing Address - Country:US
Mailing Address - Phone:727-347-7827
Mailing Address - Fax:727-548-5540
Practice Address - Street 1:2201 58TH STREET N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-347-7827
Practice Address - Fax:727-548-5540
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380788600Medicaid
FL22410OtherBCBS
FL380788600Medicaid
FL22410ZMedicare ID - Type UnspecifiedMEDICARE