Healthcare Provider Details

I. General information

NPI: 1477599595
Provider Name (Legal Business Name): THOMAS C GOBBIE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WATERDAM PLAZA DR STE 260
MC MURRAY PA
15317-5411
US

IV. Provider business mailing address

2000 WATERDAM PLAZA DR STE 260
MC MURRAY PA
15317-5411
US

V. Phone/Fax

Practice location:
  • Phone: 724-969-4242
  • Fax: 724-969-4244
Mailing address:
  • Phone: 724-969-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC-007028-L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier01915544
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier217097
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 3
Identifier911879
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBLUE CROSS BLUE SHIELD
# 4
Identifier0069030001
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCIGNA
# 5
Identifier2108975000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPERSONAL CHOICE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: