Fred Lloyd Gibson IV, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

12141 Issued in FL

Practice address

12627 San Jose Blvd Ste 305
Jacksonville, FL 32223-8639

Phone

(904) 683-4376

NPI assigned

Nov 16, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sambursky Chiropractic LLC

  • Chiropractor
  • Jacksonville, FL
  • NPI 1073740189
  NPD
• Summit Integrative Health, LLC

  • General Practice Physician
  • Jacksonville, FL
  • NPI 1295202984
  NPD (past)

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695686400000",
    "number": "1578077228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 LAKE KATHRYN CIR",
            "city": "CASSELBERRY",
            "state": "FL",
            "postal_code": "327073001",
            "telephone_number": "407-949-7037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12627 SAN JOSE BLVD STE 305",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322238639",
            "telephone_number": "904-683-4376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "FRED",
        "middle_name": "LLOYD",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-16",
        "last_updated": "2023-09-26",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "12141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashton Gibson, LPC
• Brittany Aneice Gibson, APRN, FNP-BC
• Deborah Denise Gibson, APRN
• Deveni Gibson
• Elizabeth Margaret Gibson, MHCI
• Katherine Woody Gibson, MA,CCC-SLP
• Loren Gibson
• Mollie Gibson, QASP
• Neil William Carlton Gibson, MD
• Shamara Gibson, LCSW

• Chiropractor in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Chiropractor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.