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Individual
DR. LARRY ELISHA GIBSON
Active
Individual
DR. LARRY ELISHA GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
Primary
CHIR001656
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I354140
MEDICARE PTAN
GA
Enumeration date
03/20/2007
Last updated
05/27/2010
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