Provider Demographics
NPI:1891091690
Name:GILLMAN, BARRY M (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:GILLMAN
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 1:17325 NW 27TH AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33056
Mailing Address - Country:US
Mailing Address - Phone:305-623-5939
Mailing Address - Fax:305-623-1541
Practice Address - Street 1:17325 NW 27TH AVENUE
Practice Address - Street 2:SUITE 111
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33056
Practice Address - Country:US
Practice Address - Phone:305-623-5939
Practice Address - Fax:305-623-1541
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor