Provider Demographics
NPI:1114327079
Name:GIBSON, JANA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:LEIGH
Last Name:GIBSON
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 1:7017 TULANE AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2338
Mailing Address - Country:US
Mailing Address - Phone:314-503-1666
Mailing Address - Fax:
Practice Address - Street 1:7649 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-3910
Practice Address - Country:US
Practice Address - Phone:314-725-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor