Individual provider Active NPI

Daniel W Gambino, DC

  • Chiropractor
  • San Diego, CA
National Provider Identifier
1265599765
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
WV741 Issued in WV
Practice address
6030 Santo Rd Ste D
San Diego, CA 92124-1196
Phone
(858) 541-0505
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X WV741 WV Primary

Addresses

Primary practice location

6030 Santo Rd Ste D
San Diego, CA 92124-1196

Mailing address

217 N 27TH St
Clarksburg, WV 26301-2310
Phone (304) 623-7800

Other practice location 1

217 North 27th Street
Clarksburg, WV 26301-2310
Phone (304) 623-7800

Other identifiers 1

IdentifierTypeStateIssuer
001706140OtherBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31087CAMDClinical Psychologist
WV741WVMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Life University, Inc Chiropractor CurrentSince Oct 11, 2024 Accepting new patients
Life University Inc Chiropractor CurrentSince Oct 11, 2024 Accepting new patients
Bodzin Chiropractic Professional Corporation Chiropractor PastSince Jun 18, 2017 Accepting new patients

Locations

1415 Barclay Cir SE
Marietta, GA 30060
Phone (770) 426-2786

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265599765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 N 27TH ST",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263012310",
            "telephone_number": "304-623-7800",
            "fax_number": "304-623-0706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6030 SANTO RD STE D",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921241196",
            "telephone_number": "858-541-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 North 27th Street",
            "address_purpose": "LOCATION",
            "city": "Clarksburg",
            "state": "WV",
            "postal_code": "263012310",
            "country_code": "US",
            "telephone_number": "304-623-7800",
            "fax_number": "304-623-0706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAMBINO",
        "first_name": "DANIEL",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WV",
            "license": "WV741",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001706140",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.