Healthcare Provider Details

I. General information

NPI: 1285713388
Provider Name (Legal Business Name): GREGORY RAYMOND GUMBERICH DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6426 LAKE WORTH ROAD
LAKE WORTH FL
33463-3008
US

IV. Provider business mailing address

6426 LAKE WORTH ROAD
LAKE WORTH FL
33463-3008
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-1600
  • Fax: 561-964-5404
Mailing address:
  • Phone: 561-964-1600
  • Fax: 561-964-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH2848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: