Provider Demographics
NPI:1811003858
Name:GILLIS, JERRY GENE JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:GENE
Last Name:GILLIS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4722 S WESTERN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5950
Mailing Address - Country:US
Mailing Address - Phone:806-353-8501
Mailing Address - Fax:806-353-0364
Practice Address - Street 1:4722 S WESTERN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5950
Practice Address - Country:US
Practice Address - Phone:806-353-8501
Practice Address - Fax:806-353-0364
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6214111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor