Provider Demographics
NPI:1841638863
Name:GHM MEDICAL CLINIC
Entity type:Organization
Organization Name:GHM MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMITRIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-644-3410
Mailing Address - Street 1:211 W 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:877-748-3269
Practice Address - Street 1:211 W 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4533
Practice Address - Country:US
Practice Address - Phone:404-644-3410
Practice Address - Fax:877-748-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11705111N00000X
TXNO195793163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty