Provider Demographics
NPI:1386771335
Name:GAMBINO FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:GAMBINO FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:304-623-7800
Mailing Address - Street 1:217 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2310
Mailing Address - Country:US
Mailing Address - Phone:304-623-7800
Mailing Address - Fax:304-623-0706
Practice Address - Street 1:217 N 27TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2310
Practice Address - Country:US
Practice Address - Phone:304-623-7800
Practice Address - Fax:304-623-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVSP01981Medicare PIN