Provider Demographics
NPI:1114069770
Name:GIBSON, HUGO VIVIER (DC, PC)
Entity type:Individual
Prefix:
First Name:HUGO
Middle Name:VIVIER
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 NW KILLARNEY LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1606
Mailing Address - Country:US
Mailing Address - Phone:816-525-4086
Mailing Address - Fax:816-525-3103
Practice Address - Street 1:1801 NW KILLARNEY LN
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1606
Practice Address - Country:US
Practice Address - Phone:816-525-4086
Practice Address - Fax:816-525-3103
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5440111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO35100018OtherGROUP # BCBSKC
MO13551028OtherPROVIDER # BCBSKC
MO35100018OtherGROUP # BCBSKC
MOU03755Medicare UPIN