Provider Demographics
NPI:1104839125
Name:GILLIS, HAROLD BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:BRIAN
Last Name:GILLIS
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:P.O. BOX 628
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069
Mailing Address - Country:US
Mailing Address - Phone:478-987-9666
Mailing Address - Fax:478-988-8091
Practice Address - Street 1:1207 MAIN STREET SUITE C
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069
Practice Address - Country:US
Practice Address - Phone:478-987-9666
Practice Address - Fax:478-988-8091
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO05526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADH0819OtherPALMETTO GBA RAILROAD MEDICARE
GA000806616AMedicaid
GADH0819OtherPALMETTO GBA RAILROAD MEDICARE