Provider Demographics
NPI:1437700515
Name:GILLIGAN, CARA
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:GILLIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 MEAD RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3639
Mailing Address - Country:US
Mailing Address - Phone:404-355-5499
Mailing Address - Fax:
Practice Address - Street 1:409 MEAD RD UNIT 3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3639
Practice Address - Country:US
Practice Address - Phone:404-355-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor