Provider Demographics
NPI:1396085460
Name:GIBSON CHIROPRACTIC FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:GIBSON CHIROPRACTIC FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:734-669-8200
Mailing Address - Street 1:15151 SHARON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48158-9500
Mailing Address - Country:US
Mailing Address - Phone:734-669-8200
Mailing Address - Fax:734-669-8282
Practice Address - Street 1:2350 WASHTENAW AVENUE
Practice Address - Street 2:SUITE 12
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-4525
Practice Address - Country:US
Practice Address - Phone:734-669-8200
Practice Address - Fax:734-669-8282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-26
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty