Provider Demographics
NPI:1366655268
Name:GIBBS, ADAM MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MATTHEW
Last Name:GIBBS
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 1:135 OPDYKE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:62233-1446
Mailing Address - Country:US
Mailing Address - Phone:618-826-2092
Mailing Address - Fax:
Practice Address - Street 1:423 W HOLMES ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:IL
Practice Address - Zip Code:62233
Practice Address - Country:US
Practice Address - Phone:618-826-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.010935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor