Provider Demographics
NPI:1821178559
Name:DR. SCOTT H GIBBONS AND DEBRA F GIBBONS INC
Entity Type:Organization
Organization Name:DR. SCOTT H GIBBONS AND DEBRA F GIBBONS INC
Other - Org Name:BRIDGETOWER CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:HANSEN
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:208-846-8898
Mailing Address - Street 1:3120 W BELLTOWER DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7701
Mailing Address - Country:US
Mailing Address - Phone:208-846-8898
Mailing Address - Fax:
Practice Address - Street 1:3120 W BELLTOWER DR
Practice Address - Street 2:SUITE 150
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7744
Practice Address - Country:US
Practice Address - Phone:280-680-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-1199111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty