Provider Demographics
NPI:1053124362
Name:GARRISON, GABRIEL JACOB (DC)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JACOB
Last Name:GARRISON
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 1:1103 NATURE VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7454
Mailing Address - Country:US
Mailing Address - Phone:854-812-5273
Mailing Address - Fax:
Practice Address - Street 1:1103 NATURE VIEW CIR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7454
Practice Address - Country:US
Practice Address - Phone:854-812-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15371111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor