Provider Demographics
NPI:1265599765
Name:GAMBINO, DANIEL W (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:W
Last Name:GAMBINO
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 1:217 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2310
Mailing Address - Country:US
Mailing Address - Phone:304-623-7800
Mailing Address - Fax:304-623-0706
Practice Address - Street 1:6030 SANTO RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1196
Practice Address - Country:US
Practice Address - Phone:858-541-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
001706140OtherBCBS
4056821Medicare UPIN