Provider Demographics
NPI:1235439340
Name:KOVELMAN, GABRIELLE (DC)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:KOVELMAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MOBIL AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-482-0105
Mailing Address - Fax:805-482-0205
Practice Address - Street 1:266 MOBIL AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6328
Practice Address - Country:US
Practice Address - Phone:805-482-0105
Practice Address - Fax:805-482-0205
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor