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General NPI Number Information
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NPI Number | 1164053153
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Entity Type | Individual
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Provider Name | BYRON ETHAN GAMBOL AGAPAY DC
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Gender | Male
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 8515 FALLS OF NEUSE RD
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City | RALEIGH
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State | NC
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Zip | 27615-3513
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Country | US
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Telephone | 919-582-7057
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Fax |
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Provider Business Mailing Address
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Address Line | 503 COTTAGE LN
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City | DURHAM
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State | NC
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Zip | 27713-7303
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Country | US
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Telephone | 808-781-2772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6061
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License Number State | OR
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