Provider Demographics
NPI:1790783967
Name:GIBSON, DOROTHY JEAN (MS, DC)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:JEAN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W COLT SQUARE DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-2814
Mailing Address - Country:US
Mailing Address - Phone:479-587-0227
Mailing Address - Fax:479-587-0227
Practice Address - Street 1:93 W COLT SQUARE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-2814
Practice Address - Country:US
Practice Address - Phone:479-587-0227
Practice Address - Fax:479-587-0227
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE4815OtherSUBMITTER NUMBER
AR5B410OtherGROUP NUMBER
ARU44562Medicare UPIN
AR59951Medicare ID - Type Unspecified