Provider Demographics
NPI:1093798787
Name:GILMAN, KENNETH ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:GILMAN
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 1:1636 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2977
Mailing Address - Country:US
Mailing Address - Phone:931-647-3692
Mailing Address - Fax:
Practice Address - Street 1:1636 MADISON ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4911
Practice Address - Country:US
Practice Address - Phone:931-647-3692
Practice Address - Fax:931-647-0279
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN166425100OtherU.S. DEPT OF LABOR
TN1356690754OtherNPI FOR GROUP
TN3125516OtherBLUECROSS BLUESHIELD
TN350046998OtherRAILROAD BENEFICIARY
TN3125516OtherBLUECROSS BLUESHIELD
TN3125516OtherBLUECROSS BLUESHIELD