Provider Demographics
NPI:1700250347
Name:EASTON POND CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:EASTON POND CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:401-848-7634
Mailing Address - Street 1:272 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5238
Mailing Address - Country:US
Mailing Address - Phone:401-848-7634
Mailing Address - Fax:401-842-0680
Practice Address - Street 1:272 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-5238
Practice Address - Country:US
Practice Address - Phone:401-848-7634
Practice Address - Fax:401-842-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00302111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty