MEDICARE: DAVID E. GAUSSOIN D.C. 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	261QM2500X	Medical Specialty Clinic/Center	DC11585	CA

General Provider Information

NPI Number	:	1295145308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID E. GAUSSOIN D.C. INC.

Provider Business Mailing Address
First Line	:	3539 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-7032
Country	:	US
Telephone Number	:	619-287-0322
Fax Number	:	619-287-2643

Provider Business Practice Location Address
First Line	:	3539 COLLEGE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-7032
Country	:	US
Telephone Number	:	619-287-0322
Fax Number	:	619-287-2643

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID EDWARD GAUSSOIN
Credential	:	DC
Telephone Number	:	619-287-0322

Provider Enumeration Date	:	04/29/2014
Last Update Date	:	04/29/2014

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