Provider Demographics
NPI:1942354220
Name:LIBOIRON, GERARD PATRICK (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:PATRICK
Last Name:LIBOIRON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 DOUBLE CREEK DR STE 5003
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3844
Mailing Address - Country:US
Mailing Address - Phone:512-733-8838
Mailing Address - Fax:
Practice Address - Street 1:2201 DOUBLE CREEK DR STE 5003
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3844
Practice Address - Country:US
Practice Address - Phone:512-733-8838
Practice Address - Fax:512-733-8828
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1942354220OtherNPI
TX8F4902Medicare PIN
V12431Medicare UPIN