Provider Demographics
NPI:1780695122
Name:GILLIAM, HOWARD L (DO, ND)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:L
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:DO, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 663
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-0663
Mailing Address - Country:US
Mailing Address - Phone:256-722-0555
Mailing Address - Fax:256-830-5135
Practice Address - Street 1:1230 SLAUGHTER RD
Practice Address - Street 2:SUITE C
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5900
Practice Address - Country:US
Practice Address - Phone:256-722-0555
Practice Address - Fax:256-830-5135
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68416Medicare UPIN