Healthcare Provider Details

I. General information

NPI: 1053317230
Provider Name (Legal Business Name): JEFFREY G. GAMBLE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77564 COUNTRY CLUB DR STE 320
PALM DESERT CA
92211
US

IV. Provider business mailing address

81566 RANCHO SANTANA DR
LA QUINTA CA
92253-9094
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-1589
  • Fax: 760-610-1633
Mailing address:
  • Phone: 760-610-1589
  • Fax: 760-610-1633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC17145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: