Provider Demographics
NPI:1093768814
Name:GILLMAN, ADAM ROSS (DC)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROSS
Last Name:GILLMAN
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 1:14 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1176
Mailing Address - Country:US
Mailing Address - Phone:609-383-0700
Mailing Address - Fax:609-383-0703
Practice Address - Street 1:1423 TILTON RD STE 4
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1857
Practice Address - Country:US
Practice Address - Phone:609-383-0700
Practice Address - Fax:609-383-0703
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC005980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065682WVTMedicare PIN