Provider Demographics
NPI:1326197542
Name:GILMAN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:GILMAN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:G
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-681-8199
Mailing Address - Street 1:4640 SLATER RD
Mailing Address - Street 2:#100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-4043
Mailing Address - Country:US
Mailing Address - Phone:651-681-8199
Mailing Address - Fax:
Practice Address - Street 1:4640 SLATER RD
Practice Address - Street 2:#100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-4043
Practice Address - Country:US
Practice Address - Phone:651-681-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04507Medicare PIN