Provider Demographics
NPI:1912031329
Name:GILL, LAUREN THERESA (DC)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:THERESA
Last Name:GILL
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 1:618 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON BY THE SEA
Mailing Address - State:NJ
Mailing Address - Zip Code:07717-1020
Mailing Address - Country:US
Mailing Address - Phone:732-722-8660
Mailing Address - Fax:
Practice Address - Street 1:618 MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON BY THE SEA
Practice Address - State:NJ
Practice Address - Zip Code:07717-1020
Practice Address - Country:US
Practice Address - Phone:732-722-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00604800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor