Provider Demographics
NPI:1891742433
Name:GAMBLE, BEATRICE (DC)
Entity Type:Individual
Prefix:MRS
First Name:BEATRICE
Middle Name:
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-786-2300
Mailing Address - Fax:803-786-1307
Practice Address - Street 1:4010 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-786-2300
Practice Address - Fax:803-786-1307
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1043Medicaid
4214Medicare UPIN