Provider Demographics
NPI:1548586464
Name:GIBSON, THOMAS CRAIG (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CRAIG
Last Name:GIBSON
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 1:2390 E BIDWELL ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3872
Mailing Address - Country:US
Mailing Address - Phone:916-259-5000
Mailing Address - Fax:
Practice Address - Street 1:2390 E BIDWELL ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3872
Practice Address - Country:US
Practice Address - Phone:916-259-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 30989111N00000X
CASAT 13148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor