Provider Demographics
NPI:1922272277
Name:GILMARTIN, PAUL J (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:GILMARTIN
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 1:660 HAMPSHIRE RD STE 118
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2551
Mailing Address - Country:US
Mailing Address - Phone:805-496-9996
Mailing Address - Fax:
Practice Address - Street 1:660 HAMPSHIRE RD STE 118
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2551
Practice Address - Country:US
Practice Address - Phone:805-496-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC15811Medicare PIN