Provider Demographics
NPI:1407311533
Name:GUMP, SAMANTHA (DC)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:GUMP
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 1:13850 BOOKER T WASHINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:MONETA
Mailing Address - State:VA
Mailing Address - Zip Code:24121-6205
Mailing Address - Country:US
Mailing Address - Phone:941-713-1392
Mailing Address - Fax:
Practice Address - Street 1:13850 BOOKER T WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6205
Practice Address - Country:US
Practice Address - Phone:941-713-1392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12710111N00000X
VA0104-557672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor