Provider Demographics
NPI:1881674737
Name:GIBSON, TERRY M (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AMBER GROVE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5878
Mailing Address - Country:US
Mailing Address - Phone:530-893-0275
Mailing Address - Fax:530-893-2631
Practice Address - Street 1:120 AMBER GROVE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5878
Practice Address - Country:US
Practice Address - Phone:530-893-0275
Practice Address - Fax:530-893-2631
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA12679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0126790Medicare ID - Type Unspecified