Provider Demographics
NPI:1356407399
Name:GAUSSOIN, DAVID EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:GAUSSOIN
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:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-0469
Mailing Address - Country:US
Mailing Address - Phone:619-632-3243
Mailing Address - Fax:
Practice Address - Street 1:757 BROADWAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-4631
Practice Address - Country:US
Practice Address - Phone:619-287-0322
Practice Address - Fax:619-287-2643
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11585111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0115850Medicare UPIN