Provider Demographics
NPI:1659693984
Name:GULLEDGE, JILL MARIE STROM (DC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE STROM
Last Name:GULLEDGE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:MARIE
Other - Last Name:STROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:11879 W 112TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2725
Mailing Address - Country:US
Mailing Address - Phone:913-338-1112
Mailing Address - Fax:913-338-2079
Practice Address - Street 1:11960 QUIVIRA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2222
Practice Address - Country:US
Practice Address - Phone:913-402-7444
Practice Address - Fax:913-402-7450
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-05311111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1630002Medicare PIN