Provider Demographics
NPI:1629079595
Name:GIBLIN, GREGG HOWELL (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:HOWELL
Last Name:GIBLIN
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 1:5720 CONCORD PKWY S
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4611
Mailing Address - Country:US
Mailing Address - Phone:704-455-7033
Mailing Address - Fax:704-780-1368
Practice Address - Street 1:5720 CONCORD PKWY S
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4611
Practice Address - Country:US
Practice Address - Phone:704-455-7033
Practice Address - Fax:704-780-1368
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890837LMedicaid
NC2453789Medicare ID - Type Unspecified
NC890837LMedicaid