Provider Demographics
NPI:1497818496
Name:DR. PAULA GILLIAM CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:DR. PAULA GILLIAM CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-430-0021
Mailing Address - Street 1:1900 SPARKMAN DR NW #A
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816
Mailing Address - Country:US
Mailing Address - Phone:256-430-0021
Mailing Address - Fax:256-830-1364
Practice Address - Street 1:1900 SPARKMAN DR NW # A
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1124
Practice Address - Country:US
Practice Address - Phone:256-430-0021
Practice Address - Fax:256-830-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-70500OtherBLUE CROSS
AL000070500Medicare ID - Type Unspecified
AL510-70500OtherBLUE CROSS