Provider Demographics
NPI:1790233039
Name:GIBSON, BRETT T (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:T
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 1:2519 HWY 227 UNIT D
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-1189
Mailing Address - Country:US
Mailing Address - Phone:502-519-0000
Mailing Address - Fax:513-899-7146
Practice Address - Street 1:2519 HWY 227 UNIT D
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008
Practice Address - Country:US
Practice Address - Phone:502-519-0000
Practice Address - Fax:513-899-7146
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5509111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor