Provider Demographics
NPI:1770559262
Name:BIBB CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:BIBB CHIROPRACTIC CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIBB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:870-239-6038
Mailing Address - Street 1:1400 WEST COURT STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450
Mailing Address - Country:US
Mailing Address - Phone:870-239-6038
Mailing Address - Fax:870-239-6037
Practice Address - Street 1:1400 WEST COURT STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-239-6038
Practice Address - Fax:870-239-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00093318OtherRAILROAD MEDICARE
AR15717000040OtherQUAL CHOICE
U47180Medicare UPIN