Provider Demographics
NPI:1043818693
Name:100 PERCENT CHIROPRACTIC GIBSON LLC
Entity Type:Organization
Organization Name:100 PERCENT CHIROPRACTIC GIBSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:912-614-1795
Mailing Address - Street 1:11 CHARLEY HARPER DR STE 140
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-0027
Mailing Address - Country:US
Mailing Address - Phone:912-614-1795
Mailing Address - Fax:
Practice Address - Street 1:11 CHARLEY HARPER DR STE 140
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-0027
Practice Address - Country:US
Practice Address - Phone:912-614-1795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty