Provider Demographics
NPI:1598826539
Name:KIBBY, JOHN F (DC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
Last Name:KIBBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01438111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522010294OtherTAX IDENTIFICATION NUMBER
MDT205001OtherCAREFIRST DC FEP
MD42443403OtherAETNA
MDLX18KIOtherCAREFIRST MD
MDT205001OtherCAREFIRST DC FEP
MDM394Medicare ID - Type Unspecified