Provider Demographics
NPI:1821152133
Name:GILLETTE, TERRI JO (DC)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:JO
Last Name:GILLETTE
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 1:1745 LITTLE WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-6849
Mailing Address - Country:US
Mailing Address - Phone:815-941-9790
Mailing Address - Fax:
Practice Address - Street 1:1013 LIBERTY ST
Practice Address - Street 2:APT. 104 D
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-1510
Practice Address - Country:US
Practice Address - Phone:815-941-5117
Practice Address - Fax:815-941-5118
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038010842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor