Provider Demographics
NPI:1154402006
Name:BIBB, JOHN G (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:BIBB
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W COURT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4134
Mailing Address - Country:US
Mailing Address - Phone:870-239-6038
Mailing Address - Fax:870-239-6037
Practice Address - Street 1:1400 W COURT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-4134
Practice Address - Country:US
Practice Address - Phone:870-239-6038
Practice Address - Fax:870-239-6037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5S674OtherAR BLUECROSS BLUESHIELD
AR15717000040OtherQUALCHOICE
ARP00093318OtherRAILROAD MEDICARE
AR5S674OtherAR BLUECROSS BLUESHIELD
ARP00093318OtherRAILROAD MEDICARE