Mary Gibson

Primary specialty

Pediatric ChiropractorTaxonomy code 111NP0017X

License

0104557932 Issued in VA

Practice address

7310 Heritage Village PLZ Unit 101
Gainesville, VA 20155-3303

Phone

(571) 248-6488

NPI assigned

Jun 24, 2024

Last updated

Jun 24, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lighthouse Chiropractic LLC

  • Chiropractor
  • Gainesville, VA
  • NPI 1891138350

  Single Specialty

  NPD

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

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1770327868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 HICKORY HOLLOW DR",
            "city": "CATLETT",
            "state": "VA",
            "postal_code": "201191719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7310 HERITAGE VILLAGE PLZ UNIT 101",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201553303",
            "telephone_number": "571-248-6488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NP0017X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Pediatric Chiropractor",
            "state": "VA",
            "license": "0104557932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Gendron-Trainer, CNS-BC, DNP
• Genesis Health and Rehab Services
• Kenneth W Gerard, M.D.
• Giant of Maryland LLC (Giant Pharmacy 257)
• Mark Gibbs
• Sophia Theodora Ann Gillam
• Howard E Gold, M.D.
• Tracy Goodwill
• Rama Goswami, DDS
• Carol Lynne Govoni, DPT

• Pediatric Chiropractor in Gainesville, VA
• Providers in Gainesville, VA by specialty
• Pediatric Chiropractor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.