Provider Demographics
NPI:1275966616
Name:GIBSON, TODD JACKSON (DC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:JACKSON
Last Name:GIBSON
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 1:229 PEACHTREE ST
Mailing Address - Street 2:SUITE A-01
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-522-5552
Mailing Address - Fax:404-522-5151
Practice Address - Street 1:229 PEACHTREE ST NE
Practice Address - Street 2:#01
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1601
Practice Address - Country:US
Practice Address - Phone:404-522-5552
Practice Address - Fax:404-522-5151
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007906111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor