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General NPI Number Information
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NPI Number | 1386771335
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Entity Type | Organization
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Legal Business Name | GAMBINO FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 217 N 27TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2310
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Country | US
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Telephone | 304-623-7800
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Fax | 304-623-0706
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Provider Business Mailing Address
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Address Line | 217 N 27TH ST
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City | CLARKSBURG
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State | WV
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Zip | 26301-2310
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Country | US
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Telephone | 304-623-7800
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Fax | 304-623-0706
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DANIEL GAMBINO
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Credential | D C
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Telephone | 304-623-7800
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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 | WV-741
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License Number State | WV
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