Provider Demographics
NPI:1982444550
Name:GANDIA, JOSUE ALEXIS (DC)
Entity type:Individual
Prefix:
First Name:JOSUE
Middle Name:ALEXIS
Last Name:GANDIA
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:G4 ARCADIA CT
Mailing Address - Street 2:
Mailing Address - City:EASTAMPTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-3352
Mailing Address - Country:US
Mailing Address - Phone:939-328-0753
Mailing Address - Fax:
Practice Address - Street 1:81 VICTOR HEIGHTS PKWY
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8926
Practice Address - Country:US
Practice Address - Phone:585-924-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC0800900111N00000X
NYX013843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor