Provider Demographics
NPI:1619989241
Name:GIBBS, SEAN FITZPATRICK (BS, DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:FITZPATRICK
Last Name:GIBBS
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 SO. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:IL
Mailing Address - Zip Code:61360
Mailing Address - Country:US
Mailing Address - Phone:815-357-6858
Mailing Address - Fax:815-357-6857
Practice Address - Street 1:260 SO. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:IL
Practice Address - Zip Code:61360
Practice Address - Country:US
Practice Address - Phone:815-357-6858
Practice Address - Fax:815-357-6857
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038008768Medicaid
IL05023003OtherBCBSIL PROVIDER #
U76003Medicare UPIN
IL038008768Medicaid