Provider Demographics
NPI:1093941338
Name:GILMORE, JOSEPH FRASER
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRASER
Last Name:GILMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 FAIRBANKS RD
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4938
Mailing Address - Country:US
Mailing Address - Phone:603-819-9356
Mailing Address - Fax:
Practice Address - Street 1:145 FAIRBANKS RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4938
Practice Address - Country:US
Practice Address - Phone:603-819-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3306111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor