Provider Demographics
NPI:1699557413
Name:GIBSON, ERICA ADAIR (DC, ATC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ADAIR
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25303-1417
Mailing Address - Country:US
Mailing Address - Phone:304-768-6106
Mailing Address - Fax:304-746-0608
Practice Address - Street 1:135 7TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25303-1417
Practice Address - Country:US
Practice Address - Phone:304-768-6106
Practice Address - Fax:304-746-0608
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1090111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor