Provider Demographics
NPI:1881038040
Name:GILMORE, SEAN PATRICK (DC)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:PATRICK
Last Name:GILMORE
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 1:30 B NORTH WILLIAMS STREET
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-4471
Mailing Address - Country:US
Mailing Address - Phone:815-893-8150
Mailing Address - Fax:815-768-3676
Practice Address - Street 1:30 B NORTH WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4471
Practice Address - Country:US
Practice Address - Phone:815-893-8150
Practice Address - Fax:815-768-3676
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038012399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor