Provider Demographics
NPI:1003150491
Name:GILLFILLAN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GILLFILLAN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLFILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-634-4856
Mailing Address - Street 1:955 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-2615
Mailing Address - Country:US
Mailing Address - Phone:419-634-4856
Mailing Address - Fax:
Practice Address - Street 1:955 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-2615
Practice Address - Country:US
Practice Address - Phone:419-634-4856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4321111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty