Provider Demographics
NPI:1639672280
Name:GILL, ROSY (DC)
Entity Type:Individual
Prefix:
First Name:ROSY
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16925 S HARLAN RD STE 306
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8780
Mailing Address - Country:US
Mailing Address - Phone:209-323-0022
Mailing Address - Fax:
Practice Address - Street 1:16925 S HARLAN RD STE 306
Practice Address - Street 2:
Practice Address - City:LATHROP
Practice Address - State:CA
Practice Address - Zip Code:95330-8780
Practice Address - Country:US
Practice Address - Phone:209-323-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor