Healthcare Provider Details

I. General information

NPI: 1063533628
Provider Name (Legal Business Name): GOBER CHIROPRACTIC CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE. 106
WHITE MARSH MD
21162-5500
US

IV. Provider business mailing address

5430 CAMPBELL BLVD STE. 106
WHITE MARSH MD
21162-5500
US

V. Phone/Fax

Practice location:
  • Phone: 443-725-4930
  • Fax: 443-725-4933
Mailing address:
  • Phone: 443-725-4930
  • Fax: 443-725-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number03470
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier23ZK
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST
# 2
Identifier6146
Identifier TypeOTHER
Identifier StateMD
Identifier IssuerCAREFIRST

VIII. Authorized Official

Name: DR. TIMOTHY GOBER
Title or Position: OWNER
Credential: D.C.
Phone: 443-725-4930