Healthcare Provider Details

I. General information

NPI: 1104831940
Provider Name (Legal Business Name): GAMBLE CHIROPRACTIC CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 S WASHINGTON ST
CARPENTERSVILLE IL
60110-2627
US

IV. Provider business mailing address

208 S WASHINGTON ST
CARPENTERSVILLE IL
60110-2627
US

V. Phone/Fax

Practice location:
  • Phone: 847-428-6201
  • Fax: 847-428-6210
Mailing address:
  • Phone: 847-428-6201
  • Fax: 847-428-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. JACK W. GAMBLE
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 847-428-6201