Provider Demographics
NPI:1306840681
Name:FAIR GAMBACORTA, TORRI (DC)
Entity Type:Individual
Prefix:DR
First Name:TORRI
Middle Name:
Last Name:FAIR GAMBACORTA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TORRI
Other - Middle Name:
Other - Last Name:FAIR GAMBACORTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:D,C
Mailing Address - Street 1:605 N SPENCE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-4263
Mailing Address - Country:US
Mailing Address - Phone:919-759-2040
Mailing Address - Fax:919-751-3001
Practice Address - Street 1:605 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4263
Practice Address - Country:US
Practice Address - Phone:919-759-2040
Practice Address - Fax:919-751-3001
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3284111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085UGMedicaid
085UGOtherBCBS
V02640Medicare UPIN
NC89085UGMedicaid