Provider Demographics
NPI:1437281672
Name:KURILLA, GARY JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAMES
Last Name:KURILLA
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 1:3886 STATE ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-569-1177
Mailing Address - Fax:805-569-1851
Practice Address - Street 1:3886 STATE ST
Practice Address - Street 2:SUITE F
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-569-1177
Practice Address - Fax:805-569-1851
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
50900OtherASH DOC ID
11415039OtherCAQH