Individual
DR. MARK WILLIAM GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
7A REICH STREET, MARSING, ID 83639-0252
(208) 896-5520
(208) 896-9920
Mailing address
PO BOX 252, 7A REICH ST., MARSING, ID 83639-0252
(208) 921-1781
(208) 896-9920
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-1130
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8078441
—
ID
Enumeration date
06/17/2005
Last updated
03/10/2008
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