Provider Demographics
NPI:1568546133
Name:GILLILAND, TROY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:LEE
Last Name:GILLILAND
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 1:2755 E SHAW AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8230
Mailing Address - Country:US
Mailing Address - Phone:559-490-1323
Mailing Address - Fax:559-226-1333
Practice Address - Street 1:2755 E SHAW AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8230
Practice Address - Country:US
Practice Address - Phone:559-490-1323
Practice Address - Fax:559-226-1333
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17981OtherCHIROPRACTOR
CA17981OtherCHIROPRACTOR
CA0179810Medicare UPIN