Provider Demographics
NPI:1407010184
Name:HUGO V GIBSON DC, PC
Entity Type:Organization
Organization Name:HUGO V GIBSON DC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGO
Authorized Official - Middle Name:VIVIER
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-525-4086
Mailing Address - Street 1:1801 NW KILLARNEY LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1606
Mailing Address - Country:US
Mailing Address - Phone:816-525-4086
Mailing Address - Fax:816-525-3103
Practice Address - Street 1:1801 NW KILLARNEY LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1606
Practice Address - Country:US
Practice Address - Phone:816-525-4086
Practice Address - Fax:816-525-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35100018OtherBCBS GROUP NUMBER
MO1114069770OtherINDIVIDUAL NPI
MO13551028OtherBCBS PROVIDER NUMBER
MO35100018OtherBCBS GROUP NUMBER