Provider Demographics
NPI:1770888232
Name:GILLIES, JASON R (DC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:R
Last Name:GILLIES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:824 E FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6375
Mailing Address - Country:US
Mailing Address - Phone:719-634-2579
Mailing Address - Fax:719-634-2371
Practice Address - Street 1:824 E FILLMORE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6375
Practice Address - Country:US
Practice Address - Phone:719-634-2579
Practice Address - Fax:719-634-2371
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6562111N00000X
COPTA.0013124225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant