Provider Demographics
NPI:1790434520
Name:GILLIS, KARA ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:ELIZABETH
Last Name:GILLIS
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 1:215 S MATTESON ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-3119
Mailing Address - Country:US
Mailing Address - Phone:737-299-2046
Mailing Address - Fax:
Practice Address - Street 1:2965 13TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2814
Practice Address - Country:US
Practice Address - Phone:309-793-4858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.013856111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor