Provider Demographics
NPI:1780709964
Name:GOMMEL, ROBERT ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:GOMMEL
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 1:26 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32112-2814
Mailing Address - Country:US
Mailing Address - Phone:386-698-1720
Mailing Address - Fax:
Practice Address - Street 1:611 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:FL
Practice Address - Zip Code:32112-2147
Practice Address - Country:US
Practice Address - Phone:386-698-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9741111N00000X
PADC003899L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor