Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12395 | TX |
NPI | 1003261736 |
---|---|
Provider Name | Dr. Deeborr Mbissine Gibune |
First Address | Coppell, TX 75019-5050 |
Second Address | Coppell, TX 75019-5050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2016 |
Last Update Date | 02/05/2016 |