Provider Demographics
NPI:1457491185
Name:GILMORE, JUSTIN MATHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MATHEW
Last Name:GILMORE
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 1:14801 MARKET CENTER DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-5519
Mailing Address - Country:US
Mailing Address - Phone:317-587-2727
Mailing Address - Fax:317-587-2726
Practice Address - Street 1:14801 MARKET CENTER DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-5519
Practice Address - Country:US
Practice Address - Phone:317-587-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002312A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor