Provider Demographics
NPI:1437473758
Name:GIBBONS CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GIBBONS CHIROPRACTIC, INC
Other - Org Name:ADVANCED CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-580-3277
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty