Provider Demographics
NPI:1972554921
Name:GIBBS, GRETCHEN LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:LEE
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1596 ZEMORY DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7121
Mailing Address - Country:US
Mailing Address - Phone:770-723-0068
Mailing Address - Fax:404-315-0633
Practice Address - Street 1:2298 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3101
Practice Address - Country:US
Practice Address - Phone:404-325-2856
Practice Address - Fax:404-315-0633
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor