Provider Demographics
NPI:1316725187
Name:GIBBS, JOSHUA CLAY (DC)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CLAY
Last Name:GIBBS
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 1:5572 MOSSY OAK LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9310
Mailing Address - Country:US
Mailing Address - Phone:386-795-7846
Mailing Address - Fax:
Practice Address - Street 1:5685 RED BUG LAKE RD
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-4969
Practice Address - Country:US
Practice Address - Phone:321-274-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH14074111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor