MEDICARE: GOBER CHIROPRACTIC CENTERS INC

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	03470	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	23ZK	OTHER	MD	CAREFIRST
2	6146	OTHER	MD	CAREFIRST

General Provider Information

NPI Number	:	1063533628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOBER CHIROPRACTIC CENTERS INC

Provider Business Mailing Address
First Line	:	5430 CAMPBELL BLVD
Second Line	:	STE. 106
City	:	WHITE MARSH
State	:	MD
Zip	:	21162-5500
Country	:	US
Telephone Number	:	443-725-4930
Fax Number	:	443-725-4933

Provider Business Practice Location Address
First Line	:	5430 CAMPBELL BLVD
Second Line	:	STE. 106
City	:	WHITE MARSH
State	:	MD
Zip	:	21162-5500
Country	:	US
Telephone Number	:	443-725-4930
Fax Number	:	443-725-4933

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TIMOTHY GOBER
Credential	:	D.C.
Telephone Number	:	443-725-4930

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	10/24/2008

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1780851964 — DR. NICOLE KREISMAN PH.D.
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Directions to “GOBER CHIROPRACTIC CENTERS INC ” Practice Location

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