Provider Demographics
NPI:1528330578
Name:HIBBARD, TOM (DC)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:HIBBARD
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 1:99 LONG CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6066
Mailing Address - Country:US
Mailing Address - Phone:805-409-7071
Mailing Address - Fax:
Practice Address - Street 1:99 LONG CT
Practice Address - Street 2:SUITE 102
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6066
Practice Address - Country:US
Practice Address - Phone:805-409-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor