Provider Demographics
NPI:1336295625
Name:GILMAN, STEPHEN (DC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:GILMAN
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 1:3830 W RUE DE LAMOUR AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-1153
Mailing Address - Country:US
Mailing Address - Phone:602-418-3766
Mailing Address - Fax:623-516-8699
Practice Address - Street 1:3830 W RUE DE LAMOUR AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-1153
Practice Address - Country:US
Practice Address - Phone:602-418-3766
Practice Address - Fax:623-516-8699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0935150OtherBCBS PROVIDER NUMBER
AZAZ0935150OtherBCBS PROVIDER NUMBER