Healthcare Provider Details

I. General information

NPI: 1083705958
Provider Name (Legal Business Name): JAMES G BOMBINO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 ROCK CLIFF DR
MARTINSBURG WV
25401-2835
US

IV. Provider business mailing address

285 ROCK CLIFF DR
MARTINSBURG WV
25401-2835
US

V. Phone/Fax

Practice location:
  • Phone: 304-262-9920
  • Fax: 304-262-9921
Mailing address:
  • Phone: 304-262-9920
  • Fax: 304-262-9921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number713
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number713
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: