Healthcare Provider Details

I. General information

NPI: 1295254258
Provider Name (Legal Business Name): ANDREW J GILBAUGH D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 10/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 ROSECRANS ST STE 110A
SAN DIEGO CA
92110-3232
US

IV. Provider business mailing address

1736 RED OAK DR
CORALVILLE IA
52241-3016
US

V. Phone/Fax

Practice location:
  • Phone: 319-855-8970
  • Fax:
Mailing address:
  • Phone: 319-855-8970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number36255
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: