Healthcare Provider Details

I. General information

NPI: 1861494767
Provider Name (Legal Business Name): JANET BOYLE GAUSSOIN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W. TEFFT ST. SUITE #2
NIPOMO CA
93444-7909
US

IV. Provider business mailing address

555 W. TEFFT ST. SUITE #2
NIPOMO CA
93444-7909
US

V. Phone/Fax

Practice location:
  • Phone: 805-931-0300
  • Fax: 805-931-0337
Mailing address:
  • Phone: 805-931-0300
  • Fax: 805-931-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number20193
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: