Provider Demographics
NPI:1982870267
Name:GIBSON, DONALD W (CH)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:GIBSON
Suffix:
Gender:M
Credentials:CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5191 S YOSEMITE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-3305
Mailing Address - Country:US
Mailing Address - Phone:303-771-3102
Mailing Address - Fax:303-796-0197
Practice Address - Street 1:5191 S YOSEMITE ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-3305
Practice Address - Country:US
Practice Address - Phone:303-771-3102
Practice Address - Fax:303-796-0197
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26723111N00000X
CO6191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC26723AOtherPTAN