Healthcare Provider Details

I. General information

NPI: 1538497144
Provider Name (Legal Business Name): LLOYD H GOMBERG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2009
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SE 6TH ST
BOCA RATON FL
33432-6016
US

IV. Provider business mailing address

22820 CHELSEA WOOD CT
BOCA RATON FL
33433-1143
US

V. Phone/Fax

Practice location:
  • Phone: 561-961-4030
  • Fax: 561-961-4049
Mailing address:
  • Phone: 561-613-5154
  • Fax: 561-961-4049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH8498
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: