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General NPI Number Information
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NPI Number | 1750003976
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Entity Type | Individual
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Provider Name | ROBERT E GIBBONS D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 16430 VENTURA BLVD STE 207
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City | ENCINO
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State | CA
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Zip | 91436-2141
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Country | US
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Telephone | 818-478-9401
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Fax |
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Provider Business Mailing Address
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Address Line | 765 WARWICK AVE 325
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-3720
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Country | US
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Telephone | 818-284-1728
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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 | 15717
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License Number State | CA
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