100 Percent Chiropractic Gibson LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

100 PERCENT CHIROPRACTIC GIBSON LLC

Practice address

11 Charley Harper Dr Ste 140
Cartersville, GA 30120-0027

Phone

(912) 614-1795

NPI assigned

Oct 15, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Justin Bruce Gibson, DCNPI 1336747989

Title

Owner/Doctor of Chiropractic

Phone

(912) 614-1795

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Justin Bruce Gibson, DC

  • Chiropractor
  • Cartersville, GA
  • NPI 1336747989
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602806400000",
    "number": "1043818693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 CHARLEY HARPER DR STE 140",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301200027",
            "telephone_number": "912-614-1795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 CHARLEY HARPER DR STE 140",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301200027",
            "telephone_number": "912-614-1795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "100 PERCENT CHIROPRACTIC GIBSON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-16",
        "certification_date": "2020-10-16",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER/DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "912-614-1795",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.