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General NPI Number Information
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NPI Number | 1336747989
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Entity Type | Individual
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Provider Name | JUSTIN BRUCE GIBSON DC
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Gender | Male
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 11 CHARLEY HARPER DR STE 140
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City | CARTERSVILLE
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State | GA
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Zip | 30120-0027
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Country | US
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Telephone | 912-614-1795
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Fax |
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Provider Business Mailing Address
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Address Line | 119 BELLS FERRY RD NE
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City | WHITE
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State | GA
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Zip | 30184-2852
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Country | US
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Telephone | 912-614-1795
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIRO10435
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CHIR010435
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License Number State | GA
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