Provider Demographics
NPI:1851548309
Name:GIBBONS, KRISTINA JEANNE (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:JEANNE
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KRISTINA
Other - Middle Name:JEANNE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:430 MAIN ST
Mailing Address - Street 2:PO BOX 726
Mailing Address - City:WELLSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66092-8878
Mailing Address - Country:US
Mailing Address - Phone:782-883-9355
Mailing Address - Fax:785-993-4030
Practice Address - Street 1:430 MAIN
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66092-0726
Practice Address - Country:US
Practice Address - Phone:785-883-9355
Practice Address - Fax:785-883-4030
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1073002OtherMEDICARE PTAN
KS660128001OtherMEDICARE PTAN