MEDICARE: JEFFREY G. GAMBLE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC17145	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC17145	OTHER	CA	CHIROPRACTIC LICENSE

General Provider Information

NPI Number	:	1053317230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY G. GAMBLE D.C.

Provider Business Mailing Address
First Line	:	81566 RANCHO SANTANA DR
Second Line	:
City	:	LA QUINTA
State	:	CA
Zip	:	92253-9094
Country	:	US
Telephone Number	:	760-610-1589
Fax Number	:	760-610-1633

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR STE 320
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211
Country	:	US
Telephone Number	:	760-610-1589
Fax Number	:	760-610-1633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	05/14/2018

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