Provider Demographics
NPI:1629387899
Name:KIBBE, FARA EUNICE (DC)
Entity Type:Individual
Prefix:
First Name:FARA
Middle Name:EUNICE
Last Name:KIBBE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 TEEL PKWY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4428
Mailing Address - Country:US
Mailing Address - Phone:972-704-1890
Mailing Address - Fax:972-704-1891
Practice Address - Street 1:8811 TEEL PKWY
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4428
Practice Address - Country:US
Practice Address - Phone:972-704-1890
Practice Address - Fax:972-704-1891
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11587111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist