Provider Demographics
NPI:1386749406
Name:GIBSON, ROBERT DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLAS
Last Name:GIBSON
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 1:12424 BIG TIMBER DR
Mailing Address - Street 2:UNIT 4
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-6410
Mailing Address - Country:US
Mailing Address - Phone:303-838-8443
Mailing Address - Fax:304-838-7794
Practice Address - Street 1:12424 BIG TIMBER DR
Practice Address - Street 2:UNIT 4
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-6410
Practice Address - Country:US
Practice Address - Phone:303-838-8443
Practice Address - Fax:304-838-7794
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3874111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC29433Medicare PIN