MEDICARE: GABRIEL GOLDMAN CHIROPRACTIC PROFESSIONAL CORPORATION

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	30832	CA

General Provider Information

NPI Number	:	1790055119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIEL GOLDMAN CHIROPRACTIC PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1004 NW MILWAUKEE AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2245
Country	:	US
Telephone Number	:	949-336-0025
Fax Number	:	949-336-0026

Provider Business Practice Location Address
First Line	:	1004 NW MILWAUKEE AVE STE 200
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2245
Country	:	US
Telephone Number	:	949-336-0025
Fax Number	:	949-336-0026

Authorized Official
Title or Position	:	PRESIDENT / CHIROPRACTOR
Name	:	DR. GABRIEL SETH GOLDMAN
Credential	:	DC
Telephone Number	:	949-336-0025

Provider Enumeration Date	:	01/02/2012
Last Update Date	:	06/10/2020

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