Provider Demographics
NPI:1972637056
Name:GAUDINO, BRUCE D (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:GAUDINO
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 1:1950 S BREA CANYON RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4015
Mailing Address - Country:US
Mailing Address - Phone:909-612-1060
Mailing Address - Fax:909-612-1059
Practice Address - Street 1:1950 S BREA CANYON RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4015
Practice Address - Country:US
Practice Address - Phone:909-612-1060
Practice Address - Fax:909-612-1059
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC13914111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78449ZOtherBCBS
CAZZZ78449ZOtherBCBS
CADC13914Medicare PIN
CAWDC13914Medicare PIN