Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 11-3748810 | IL |
NPI | 1003022187 |
---|---|
Provider Name | Dr. Kimberly Gibas |
First Address | South Barrington, IL 60010-9115 |
Second Address | South Barrington, IL 60010-9115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04522777 | (02) | IL |