Provider Demographics
NPI:1265479505
Name:GILLIAM, ARNETRA (DC)
Entity Type:Individual
Prefix:
First Name:ARNETRA
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S NAPERVILLE RD
Mailing Address - Street 2:STE. C
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5473
Mailing Address - Country:US
Mailing Address - Phone:630-690-4040
Mailing Address - Fax:630-690-4074
Practice Address - Street 1:311 S NAPERVILLE RD
Practice Address - Street 2:STE. C
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5473
Practice Address - Country:US
Practice Address - Phone:630-690-4040
Practice Address - Fax:630-690-4074
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor