Provider Demographics
NPI:1225037245
Name:GILSON, CLIFFORD JOHN (DC)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:JOHN
Last Name:GILSON
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:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:OK
Mailing Address - Zip Code:73068-2065
Mailing Address - Country:US
Mailing Address - Phone:405-872-5868
Mailing Address - Fax:405-872-5887
Practice Address - Street 1:1101 PARKWOODS DR
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:OK
Practice Address - Zip Code:73068-9330
Practice Address - Country:US
Practice Address - Phone:405-872-5868
Practice Address - Fax:405-872-5887
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5841654OtherAETNA
OK8022776002OtherCIGNA
OK1856Medicaid
U35924Medicare UPIN
OK350039896Medicare ID - Type UnspecifiedRAILROAD
OK243428802Medicare PIN