Provider Demographics
NPI:1417244963
Name:GILLEZEAU, PAUL MAURICE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MAURICE
Last Name:GILLEZEAU
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 1:3383 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1703
Mailing Address - Country:US
Mailing Address - Phone:716-980-6107
Mailing Address - Fax:716-980-6205
Practice Address - Street 1:3383 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1703
Practice Address - Country:US
Practice Address - Phone:716-980-6107
Practice Address - Fax:716-980-6205
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor