Provider Demographics
NPI:1689679797
Name:GIBSON, CHRIS SCOTT (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:SCOTT
Last Name:GIBSON
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 1:2906 DARWIN ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-4510
Mailing Address - Country:US
Mailing Address - Phone:916-925-2225
Mailing Address - Fax:916-925-2220
Practice Address - Street 1:2906 DARWIN ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-4510
Practice Address - Country:US
Practice Address - Phone:916-925-2225
Practice Address - Fax:916-925-2220
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-11-03
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CA23817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0238170Medicaid
CADC0238170Medicaid