Provider Demographics
NPI:1144410416
Name:GILLARD, DOUGLAS M
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:GILLARD
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 1:1190 S BASCOM AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3547
Mailing Address - Country:US
Mailing Address - Phone:408-294-3500
Mailing Address - Fax:408-294-3444
Practice Address - Street 1:1190 S BASCOM AVE STE 222
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3547
Practice Address - Country:US
Practice Address - Phone:408-294-3500
Practice Address - Fax:408-294-3444
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18417111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01787ZMedicaid
CAZZZ01787ZMedicaid