Provider Demographics
NPI:1447395009
Name:GIBBLE, THOMAS GRANT (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GRANT
Last Name:GIBBLE
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 1:32 OLD SOUTH CT
Mailing Address - Street 2:APARTMENT B
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-8623
Mailing Address - Country:US
Mailing Address - Phone:843-689-6551
Mailing Address - Fax:
Practice Address - Street 1:435 WILLIAM HILTON PKWY
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2440
Practice Address - Country:US
Practice Address - Phone:843-689-6551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2041111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician