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General NPI Number Information
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NPI Number | 1669929980
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Entity Type | Organization
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Legal Business Name | GIBSON CHIROPRACTIC CENTER, PLLC
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Dates
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Enumeration Date | 09/02/2016
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 101 LATTNER CT SUITE 301
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City | MORRISVILLE
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State | NC
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Zip | 27560-6843
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Country | US
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Telephone | 919-757-4410
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Fax | 919-200-7104
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Provider Business Mailing Address
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Address Line | 101 LATTNER CT SUITE 301
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City | MORRISVILLE
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State | NC
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Zip | 27560-6843
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Country | US
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Telephone | 919-757-4410
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Fax | 919-200-7104
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | LUKE GIBSON
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Credential | D.C.
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Telephone | 919-757-4410
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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 | 4211
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License Number State | NC
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