Provider Demographics
NPI:1790055119
Name:GABRIEL GOLDMAN CHIROPRACTIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GABRIEL GOLDMAN CHIROPRACTIC PROFESSIONAL CORPORATION
Other - Org Name:OC CHIROPRACTIC CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT / CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-336-0025
Mailing Address - Street 1:1004 NW MILWAUKEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2245
Mailing Address - Country:US
Mailing Address - Phone:949-336-0025
Mailing Address - Fax:949-336-0026
Practice Address - Street 1:1004 NW MILWAUKEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2245
Practice Address - Country:US
Practice Address - Phone:949-336-0025
Practice Address - Fax:949-336-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-02
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty