Healthcare Provider Details

I. General information

NPI: 1114971447
Provider Name (Legal Business Name): WAYNE B GIBBONS D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W PASSAIC ST
ROCHELLE PARK NJ
07662-3120
US

IV. Provider business mailing address

221 W PASSAIC ST
ROCHELLE PARK NJ
07662-3120
US

V. Phone/Fax

Practice location:
  • Phone: 201-843-3366
  • Fax: 201-843-0331
Mailing address:
  • Phone: 201-843-3366
  • Fax: 201-843-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00286900
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00007400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: