Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1245477488 |
---|---|
Provider Name | Calvin Gibbs |
First Address | West Columbia, SC 29171-5141 |
Second Address | Columbia, SC 29204-2379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2009 |
Last Update Date | 24/09/2009 |