Provider Demographics
NPI:1659817278
Name:GIBBS, DANIEL (DC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GIBBS
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 1:4 PEARL DR
Mailing Address - Street 2:STE 1
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1927
Mailing Address - Country:US
Mailing Address - Phone:386-265-0297
Mailing Address - Fax:
Practice Address - Street 1:175 S NOVA RD
Practice Address - Street 2:SUITE 6A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-0406
Practice Address - Country:US
Practice Address - Phone:386-265-0297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 11997111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor