Healthcare Provider Details

I. General information

NPI: 1376548198
Provider Name (Legal Business Name): CLIFFORD BRENDON GIBB DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 04/05/2006

III. Provider practice location address

1400 N GILBERT RD STE M
GILBERT AZ
85234-2482
US

IV. Provider business mailing address

1400 N GILBERT RD STE M
GILBERT AZ
85234-2482
US

V. Phone/Fax

Practice location:
  • Phone: 480-558-0474
  • Fax: 480-558-0478
Mailing address:
  • Phone: 480-558-0474
  • Fax: 480-558-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7154
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: