Provider Demographics
NPI:1003022187
Name:GIBAS, KIMBERLY (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:GIBAS
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 1:33 W HIGGINS RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9115
Mailing Address - Country:US
Mailing Address - Phone:847-426-7008
Mailing Address - Fax:847-426-7221
Practice Address - Street 1:33 W HIGGINS RD
Practice Address - Street 2:SUITE 620
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9115
Practice Address - Country:US
Practice Address - Phone:847-426-7008
Practice Address - Fax:847-426-7221
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11-3748810111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04522777Medicare UPIN
ILK22925Medicare PIN