Provider Demographics
NPI:1326070830
Name:YOUDEEM, GILBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:YOUDEEM
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 1:9919 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3827
Mailing Address - Country:US
Mailing Address - Phone:714-527-7463
Mailing Address - Fax:714-527-8962
Practice Address - Street 1:9919 WALKER ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3827
Practice Address - Country:US
Practice Address - Phone:714-527-7463
Practice Address - Fax:714-527-8962
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24875111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19142Medicare ID - Type Unspecified
CAWDC24875AMedicare ID - Type Unspecified