Provider Demographics
NPI:1669473385
Name:DANFORTH, GILBERT LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:LYNN
Last Name:DANFORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:GILBERT
Other - Middle Name:LYNN
Other - Last Name:DANFORTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PRESIDENT
Mailing Address - Street 1:12402 SLIDE RD
Mailing Address - Street 2:STE. 202
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8323
Mailing Address - Country:US
Mailing Address - Phone:806-799-6252
Mailing Address - Fax:806-799-0319
Practice Address - Street 1:12402 SLIDE RD
Practice Address - Street 2:STE. 202
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8323
Practice Address - Country:US
Practice Address - Phone:806-799-6252
Practice Address - Fax:806-799-0319
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7276111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
V76931Medicare UPIN
TX609132Medicare ID - Type Unspecified