Provider Demographics
NPI:1730382466
Name:GIPSON, BRUCE CLAY (DC)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:CLAY
Last Name:GIPSON
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 1:2027 LORRAINE RD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1420
Mailing Address - Country:US
Mailing Address - Phone:610-334-5417
Mailing Address - Fax:610-373-4636
Practice Address - Street 1:2027 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1420
Practice Address - Country:US
Practice Address - Phone:610-334-5417
Practice Address - Fax:610-373-4636
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005000L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor