Provider Demographics
NPI:1326049339
Name:PILLOW, GWEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GWEN
Middle Name:
Last Name:PILLOW
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 1:1502 SPRING ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2166
Mailing Address - Country:US
Mailing Address - Phone:805-237-2654
Mailing Address - Fax:805-237-2898
Practice Address - Street 1:1502 SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2166
Practice Address - Country:US
Practice Address - Phone:805-237-2654
Practice Address - Fax:805-237-2898
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-09-21
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CADC29264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC29264OtherBLUE CROSS PROVIDER NO.
CADC0292640OtherBLUE SHIELD PROVIDER NO.
CA1058988OtherASH PROVIDER NO.
CADC 29264OtherCA CHIROPRACTIC BOARD
CA1058988OtherASH PROVIDER NO.
CAV04007Medicare UPIN