Provider Demographics
NPI:1972504264
Name:GILFILLAN, THOMAS WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:GILFILLAN
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 1:399 STATE HWY 94
Mailing Address - Street 2:FREDON FAMILY CHIROPRACTIC
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-5154
Mailing Address - Country:US
Mailing Address - Phone:973-383-1988
Mailing Address - Fax:973-383-1844
Practice Address - Street 1:399 STATE HWY 94
Practice Address - Street 2:FREDON FAMILY CHIROPRACTIC
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-5154
Practice Address - Country:US
Practice Address - Phone:973-383-1988
Practice Address - Fax:973-383-1844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00498200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U8350Medicare UPIN
045027Medicare ID - Type Unspecified