Provider Demographics
NPI:1003985227
Name:GILMORE, JOHN BLAKE (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BLAKE
Last Name:GILMORE
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 1:1759 CREIGHTON RD
Mailing Address - Street 2:STE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-7145
Mailing Address - Country:US
Mailing Address - Phone:850-473-6767
Mailing Address - Fax:850-473-6768
Practice Address - Street 1:1759 CREIGHTON RD # B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7145
Practice Address - Country:US
Practice Address - Phone:850-473-6767
Practice Address - Fax:850-473-6768
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-30080111N00000X
FLCH9324111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor