Provider Demographics
NPI:1326288903
Name:GIBBONS, DEREK PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:PHILLIP
Last Name:GIBBONS
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 1:6035 GREENBACK LN
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-4740
Mailing Address - Country:US
Mailing Address - Phone:916-580-3277
Mailing Address - Fax:916-307-5166
Practice Address - Street 1:6035 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-4740
Practice Address - Country:US
Practice Address - Phone:916-580-3277
Practice Address - Fax:916-307-5166
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-31141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor