Provider Demographics
NPI:1144201955
Name:HIBBERT, JAROM TODD (DC)
Entity Type:Individual
Prefix:
First Name:JAROM
Middle Name:TODD
Last Name:HIBBERT
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 1:2805 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1403
Mailing Address - Country:US
Mailing Address - Phone:541-523-2495
Mailing Address - Fax:541-523-2495
Practice Address - Street 1:2805 10TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1403
Practice Address - Country:US
Practice Address - Phone:541-523-2495
Practice Address - Fax:541-523-2495
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1138111N00000X
OR3843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor