Provider Demographics
NPI: | 1477599595 |
---|---|
Name: | GOBBIE, THOMAS C (DC) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | THOMAS |
Middle Name: | C |
Last Name: | GOBBIE |
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: | 2000 WATERDAM PLAZA DR |
Mailing Address - Street 2: | STE 260 |
Mailing Address - City: | MC MURRAY |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15317-5411 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 724-969-4242 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2000 WATERDAM PLAZA DR |
Practice Address - Street 2: | STE 260 |
Practice Address - City: | MC MURRAY |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15317-5411 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-969-4242 |
Practice Address - Fax: | 724-969-4244 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-06-20 |
Last Update Date: | 2016-03-10 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | DC-007028-L | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 01915544 | Medicaid | |
PA | 217097 | Other | UPMC |
PA | 911879 | Other | BLUE CROSS BLUE SHIELD |
PA | 0069030001 | Other | CIGNA |
PA | 2108975000 | Other | PERSONAL CHOICE |
PA | 01915544 | Medicaid | |
PA | 0069030001 | Other | CIGNA |