Provider Demographics
NPI:1407022932
Name:GILL CHIROPRACTIC
Entity Type:Organization
Organization Name:GILL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:734-721-1516
Mailing Address - Street 1:2505 S WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-5431
Mailing Address - Country:US
Mailing Address - Phone:734-721-1516
Mailing Address - Fax:810-225-4630
Practice Address - Street 1:2505 S WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5431
Practice Address - Country:US
Practice Address - Phone:734-721-1516
Practice Address - Fax:810-225-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M21140Medicare PIN