Healthcare Provider Details

I. General information

NPI: 1881499507
Provider Name (Legal Business Name): JODIE GIBSON CHIROPRACTIC CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10780 SANTA MONICA BLVD STE 200
LOS ANGELES CA
90025-7614
US

IV. Provider business mailing address

25 HORIZON AVE APT B
VENICE CA
90291-3646
US

V. Phone/Fax

Practice location:
  • Phone: 870-273-5520
  • Fax:
Mailing address:
  • Phone: 870-273-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JODIE GIBSON
Title or Position: CEO
Credential: DC
Phone: 870-273-5520