Healthcare Provider Details

I. General information

NPI: 1427247949
Provider Name (Legal Business Name): DAVID FLOYD GENDREAU D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2007
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 MEDICAL CENTER DR STE 102
PERRIS CA
92571-2657
US

IV. Provider business mailing address

16702 VALLEY VIEW AVE
LA MIRADA CA
90638-5824
US

V. Phone/Fax

Practice location:
  • Phone: 951-657-1400
  • Fax: 951-657-0661
Mailing address:
  • Phone: 714-367-5360
  • Fax: 714-635-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC20598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: