Provider Demographics
NPI:1487766671
Name:BAMBERGER, GREGORY A (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:BAMBERGER
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 1:6 VENTURE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3340
Mailing Address - Country:US
Mailing Address - Phone:949-559-6030
Mailing Address - Fax:949-559-6037
Practice Address - Street 1:6 VENTURE
Practice Address - Street 2:SUITE 115
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3340
Practice Address - Country:US
Practice Address - Phone:949-559-6030
Practice Address - Fax:949-559-6037
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25305111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
469643Medicare UPIN
CADC25305Medicare ID - Type Unspecified
CABD992ZMedicare PIN