Provider Demographics
NPI:1508172503
Name:GOMACH, DEBRA (DC)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:GOMACH
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 1:2505 LEXINGTON CT
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-6310
Mailing Address - Country:US
Mailing Address - Phone:832-730-4657
Mailing Address - Fax:832-730-4675
Practice Address - Street 1:391 COLUMBIA MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-3249
Practice Address - Country:US
Practice Address - Phone:832-730-4657
Practice Address - Fax:832-430-4675
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor