Provider Demographics
NPI:1013262526
Name:GAMBOA, PATRICIA JEANNE (DC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEANNE
Last Name:GAMBOA
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 1:4805 PARK RD
Mailing Address - Street 2:STE 225
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3803
Mailing Address - Country:US
Mailing Address - Phone:704-527-7246
Mailing Address - Fax:704-527-3080
Practice Address - Street 1:4805 PARK RD
Practice Address - Street 2:STE 225
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3803
Practice Address - Country:US
Practice Address - Phone:704-527-7246
Practice Address - Fax:704-527-3080
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor