NPIMap

Organization Active NPI

Kelly Gibsonchiropractic, Inc

  • Internist Chiropractor
  • Vista, CA
National Provider Identifier
1336686153
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internist ChiropractorTaxonomy code 111NI0900X
License
DC25328 Issued in CA
Legal business name
KELLY GIBSONCHIROPRACTIC, INC
Practice address
1929 W Vista Way
Suite C
Vista, CA 92083-6004
Phone
(760) 724-5700
Fax
(760) 724-9878
NPI assigned
Jan 31, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Authorized official

Name
Dr. Kelly Marie Gibson, D.C.
Title
President
Phone
(760) 724-5700

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internist ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NI0900X DC25328 CA Primary
Nutrition ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NN1001X DC25328 CA
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X DC25328 CA
Sports Physician ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NS0005X DC10902 CA

Addresses

Primary practice location

1929 W Vista Way
Suite C
Vista, CA 92083-6004

Mailing address

1929 W Vista Way
Suite C
Vista, CA 92083-6004
Phone (760) 724-5700

National Provider Directory

National Provider Directory

Locations

1929 W Vista Way
Ste C
Vista, CA 92083
Phone (760) 724-5700

NPI Registry JSON

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485820800000",
    "number": "1336686153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1929 W VISTA WAY",
            "address_2": "SUITE C",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836004",
            "telephone_number": "760-724-5700",
            "fax_number": "760-724-9878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1929 W VISTA WAY",
            "address_2": "SUITE C",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836004",
            "telephone_number": "760-724-5700",
            "fax_number": "760-724-9878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY GIBSONCHIROPRACTIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-31",
        "last_updated": "2017-01-31",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-724-5700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NI0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Internist",
            "state": "CA",
            "license": "DC25328",
            "primary": true
        },
        {
            "code": "111NN1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Nutrition",
            "state": "CA",
            "license": "DC25328",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "DC25328",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "DC10902",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.