Provider Demographics
NPI:1811032634
Name:GIBSON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:GIBSON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-925-2225
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC023817111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30880ZMedicare ID - Type UnspecifiedGROUP NUMBER