Provider Demographics
NPI:1558406280
Name:NABONG, GIDEON CUISON (CHIROPRACTOR)
Entity Type:Individual
Prefix:
First Name:GIDEON
Middle Name:CUISON
Last Name:NABONG
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4795 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215-2327
Mailing Address - Country:US
Mailing Address - Phone:209-594-7427
Mailing Address - Fax:
Practice Address - Street 1:4795 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215-2327
Practice Address - Country:US
Practice Address - Phone:209-594-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26728111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26728Medicare ID - Type UnspecifiedCHIROPRACTIC