Provider Demographics
NPI:1649769928
Name:GAVALDON, IGNACIO (DC)
Entity Type:Individual
Prefix:
First Name:IGNACIO
Middle Name:
Last Name:GAVALDON
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 1:6951 VINTAGE LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-4095
Mailing Address - Country:US
Mailing Address - Phone:619-240-4235
Mailing Address - Fax:
Practice Address - Street 1:807 A1A
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-2827
Practice Address - Country:US
Practice Address - Phone:386-410-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12461111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor