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NPI Code Detail

MEDICARE: KEVIN CRAIG GIBSON D.C.

MEDICARE: KEVIN CRAIG GIBSON D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractorDC1980OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669434213
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN CRAIG GIBSON D.C.
Provider Business Mailing Address
First Line : 165 WILLOW BEND DR
Second Line :
City : CANFIELD
State : OH
Zip : 44406-8750
Country : US
Telephone Number : 330-533-7382
Fax Number :
Provider Business Practice Location Address
First Line : 315 STRUTHERS LIBERTY RD
Second Line :
City : CAMPBELL
State : OH
Zip : 44405-1949
Country : US
Telephone Number : 330-750-1333
Fax Number : 330-750-0203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 07/08/2007

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