Provider Demographics
NPI:1669504866
Name:GWEN SCHILLER, D.C., P.C.
Entity Type:Organization
Organization Name:GWEN SCHILLER, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SCHILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:719-598-8288
Mailing Address - Street 1:7710 N UNION BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4030
Mailing Address - Country:US
Mailing Address - Phone:719-598-8288
Mailing Address - Fax:719-260-9899
Practice Address - Street 1:7710 N UNION BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4030
Practice Address - Country:US
Practice Address - Phone:719-598-8288
Practice Address - Fax:719-260-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4536111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO519208Medicare ID - Type Unspecified