Provider Demographics
NPI:1821326950
Name:GILLESPIE, STEWART IAN (DC)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:IAN
Last Name:GILLESPIE
Suffix:
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 1:5101 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6129
Mailing Address - Country:US
Mailing Address - Phone:704-773-6076
Mailing Address - Fax:
Practice Address - Street 1:5101 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-6129
Practice Address - Country:US
Practice Address - Phone:704-773-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556447111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor