Provider Demographics
NPI:1710028469
Name:JUSTIN M GILMORE DC PC
Entity Type:Organization
Organization Name:JUSTIN M GILMORE DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:MATHEW
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-587-2727
Mailing Address - Street 1:14801 MARKET CENTER DRIVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033
Mailing Address - Country:US
Mailing Address - Phone:317-587-2727
Mailing Address - Fax:317-587-2726
Practice Address - Street 1:14801 MARKET CENTER DRIVE
Practice Address - Street 2:SUITE 150
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033
Practice Address - Country:US
Practice Address - Phone:317-587-2727
Practice Address - Fax:317-587-2726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002312A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty