Provider Demographics
NPI:1265600076
Name:GILLILAND, ROBERT G (DC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:GILLILAND
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 1:505 E NEW YORK AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-6083
Mailing Address - Country:US
Mailing Address - Phone:386-734-3795
Mailing Address - Fax:
Practice Address - Street 1:505 E NEW YORK AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-6083
Practice Address - Country:US
Practice Address - Phone:386-734-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor