Provider Demographics
NPI:1083705958
Name:BOMBINO, JAMES G (DC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:G
Last Name:BOMBINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ROCK CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2835
Mailing Address - Country:US
Mailing Address - Phone:304-262-9920
Mailing Address - Fax:304-262-9921
Practice Address - Street 1:285 ROCK CLIFF DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2835
Practice Address - Country:US
Practice Address - Phone:304-262-9920
Practice Address - Fax:304-262-9921
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV713111N00000X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2202057000Medicaid
WV2202057000Medicaid