Larry Elisha Gibson, D.C.

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

CHIR001656 Issued in GA

Practice address

3333 Northside Dr
Suite G
Macon, GA 31210-2588

Phone

(478) 477-4415

Fax

(478) 477-4419

NPI assigned

Mar 20, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274918400000",
    "number": "1093830549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 NORTHSIDE DR",
            "address_2": "SUITE G",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102588",
            "telephone_number": "478-477-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 NORTHSIDE DR",
            "address_2": "SUITE G",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312102588",
            "telephone_number": "478-477-4415",
            "fax_number": "478-477-4419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "LARRY",
        "middle_name": "ELISHA",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-20",
        "last_updated": "2010-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "GA",
            "license": "CHIR001656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "202I354140",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel John Gibbs, ATC
• Jennifer Nicole Gibbs, NP-C
• Kathryn Gibbs, DPT
• Christie Huskey Gibson, PA-AC
• Haley Nicole Gibson, PT,DPT
• Miranda Gibson, OT
• Russell Scott Gibson, MR
• Sheila Gibson
• Shekeita Gibson, RRT
• Victoria Simmons Gibson

• Orthopedic Chiropractor in Macon, GA
• Providers in Macon, GA by specialty
• Orthopedic Chiropractor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.