Provider Demographics
NPI:1609948801
Name:GILL, JACOB DWAIN (DC)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:DWAIN
Last Name:GILL
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 1:1722 N PLUM
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-5501
Mailing Address - Country:US
Mailing Address - Phone:620-669-8000
Mailing Address - Fax:620-669-8030
Practice Address - Street 1:1722 N PLUM
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-5501
Practice Address - Country:US
Practice Address - Phone:620-669-8000
Practice Address - Fax:620-669-8030
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK50104697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS60889Medicare ID - Type Unspecified
U84006Medicare UPIN