Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3093 | MA |
NPI | 1003967001 |
---|---|
Provider Name | Dr. Jill Wheeler Gibson |
First Address | Beverly, MA 01915 |
Second Address | Swampscott, MA 01907-1831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |