Provider Demographics
NPI:1487785440
Name:REBOLLIDO, GILBERT GEORGE (DC)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:GEORGE
Last Name:REBOLLIDO
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 1:17820 NW ELK MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-2148
Mailing Address - Country:US
Mailing Address - Phone:971-570-8341
Mailing Address - Fax:
Practice Address - Street 1:1911 MOUNTAIN VIEW LN STE 300
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-7244
Practice Address - Country:US
Practice Address - Phone:503-357-2826
Practice Address - Fax:503-357-4831
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor