Provider Demographics
NPI:1073676607
Name:GIBBS, TERRI L (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:GIBBS
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 1:2609 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4827
Mailing Address - Country:US
Mailing Address - Phone:208-342-7632
Mailing Address - Fax:
Practice Address - Street 1:1001 N 27TH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-2202
Practice Address - Country:US
Practice Address - Phone:208-345-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC893111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDC6665OtherBLUE CROSS
ID000010022602OtherREGENCE B SHIELD