Provider Demographics
NPI:1184131237
Name:GILMOUR, KRISTEN (DC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GILMOUR
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 1:9300 LIVINGSTON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4923
Mailing Address - Country:US
Mailing Address - Phone:240-766-0300
Mailing Address - Fax:
Practice Address - Street 1:9300 LIVINGSTON RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4923
Practice Address - Country:US
Practice Address - Phone:240-766-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557465111N00000X
MDS03691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS03961OtherMARYLAND LICENSE
VA0104557465OtherVIRGINIA LICENSE