Provider Demographics
NPI:1386910297
Name:GIBSON, LUKE A (DC)
Entity type:Individual
Prefix:DR
First Name:LUKE
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 LATTNER COURT
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7012
Mailing Address - Country:US
Mailing Address - Phone:919-757-4410
Mailing Address - Fax:919-757-4410
Practice Address - Street 1:101 LATTNER COURT
Practice Address - Street 2:SUITE 301
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7012
Practice Address - Country:US
Practice Address - Phone:919-757-4410
Practice Address - Fax:919-757-4410
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-25
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4211111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCT964G050Medicare PIN