Provider Demographics
NPI:1619256559
Name:BIBBEY, DAVID MICHAEL (OM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:BIBBEY
Suffix:
Gender:M
Credentials:OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 SE KINGS BAY DR
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4717
Mailing Address - Country:US
Mailing Address - Phone:352-464-1645
Mailing Address - Fax:352-794-6010
Practice Address - Street 1:441 SE KINGS BAY DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4717
Practice Address - Country:US
Practice Address - Phone:352-464-1645
Practice Address - Fax:352-628-0769
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist