Provider Demographics
NPI:1134488653
Name:RICHARD M. GILL, D.C. L.L.C.
Entity Type:Organization
Organization Name:RICHARD M. GILL, D.C. L.L.C.
Other - Org Name:GILL CHIROPRACTIC BY THE SEA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL-HAYSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-974-7755
Mailing Address - Street 1:312 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1339
Mailing Address - Country:US
Mailing Address - Phone:732-974-7755
Mailing Address - Fax:732-974-8946
Practice Address - Street 1:312 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1339
Practice Address - Country:US
Practice Address - Phone:732-974-7755
Practice Address - Fax:732-974-8946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00601264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051074Medicare PIN