Provider Demographics
NPI:1427247949
Name:GENDREAU, DAVID FLOYD (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FLOYD
Last Name:GENDREAU
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 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:2226 MEDICAL CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2657
Practice Address - Country:US
Practice Address - Phone:951-657-1400
Practice Address - Fax:951-657-0661
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-21
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC20598111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0205980OtherMEDI-CAL
CADC0205980OtherMEDI-CAL