Provider Demographics
NPI:1104831940
Name:GAMBLE CHIROPRACTIC CLINIC, LTD.
Entity Type:Organization
Organization Name:GAMBLE CHIROPRACTIC CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:GAMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-428-6201
Mailing Address - Street 1:208 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-2627
Mailing Address - Country:US
Mailing Address - Phone:847-428-6201
Mailing Address - Fax:847-428-6210
Practice Address - Street 1:208 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CARPENTERSVILLE
Practice Address - State:IL
Practice Address - Zip Code:60110-2627
Practice Address - Country:US
Practice Address - Phone:847-428-6201
Practice Address - Fax:847-428-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL316140Medicare ID - Type Unspecified