Provider Demographics
NPI:1851393920
Name:GAMBACORTA, MICHAEL P (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:GAMBACORTA
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 1:100 LEGENDS RD
Mailing Address - Street 2:STE A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-7076
Mailing Address - Country:US
Mailing Address - Phone:919-751-0555
Mailing Address - Fax:919-751-3001
Practice Address - Street 1:605 N SPENCE AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-4263
Practice Address - Country:US
Practice Address - Phone:919-751-0555
Practice Address - Fax:919-751-3001
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3286111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
085UFOtherBCBS
NC89085UFMedicaid
085UFOtherBCBS
NC2457602AMedicare PIN