Provider Demographics
NPI:1669533683
Name:GILLETTE, DARRIN S (DC)
Entity type:Individual
Prefix:DR
First Name:DARRIN
Middle Name:S
Last Name:GILLETTE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 25TH ST S
Mailing Address - Street 2:SUITE C
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8724
Mailing Address - Country:US
Mailing Address - Phone:701-237-4010
Mailing Address - Fax:701-237-5150
Practice Address - Street 1:825 25TH ST S
Practice Address - Street 2:SUITE C
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8724
Practice Address - Country:US
Practice Address - Phone:701-237-4010
Practice Address - Fax:701-237-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND672111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN13D48GIOtherBLUE CROSS MN
MN690082800Medicaid
ND11052Medicaid
ND606754OtherACN GROUP
ND18266OtherBLUE CROSS ND
NDU75514Medicare UPIN
ND606754OtherACN GROUP