Provider Demographics
NPI:1437144060
Name:GILL, THOMAS RAY (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAY
Last Name:GILL
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 1:3625 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-3904
Mailing Address - Country:US
Mailing Address - Phone:901-377-8706
Mailing Address - Fax:901-385-6807
Practice Address - Street 1:3625 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-3904
Practice Address - Country:US
Practice Address - Phone:901-377-8706
Practice Address - Fax:901-385-6807
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC88111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0022250OtherBCBS
TN8644815OtherCIGNA HC
TN3670086Medicare ID - Type Unspecified