Provider Demographics
NPI:1518117365
Name:KIBBY CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:KIBBY CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:KIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-721-5050
Mailing Address - Street 1:2110 PRIEST BRIDGE DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2472
Mailing Address - Country:US
Mailing Address - Phone:410-721-5050
Mailing Address - Fax:301-858-1608
Practice Address - Street 1:2110 PRIEST BRIDGE DR
Practice Address - Street 2:SUITE 6
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2472
Practice Address - Country:US
Practice Address - Phone:410-721-5050
Practice Address - Fax:301-858-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01438111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT88812OtherUPIN
MD42443403OtherAETNA
MDT205001OtherCAREFIRST DC FEP
MDLX18KIOtherCAREFIRST MD
MDLX18KIOtherCAREFIRST MD