Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4745 | KS |
NPI | 1013012673 |
---|---|
Provider Name | Dr. Chad S Gill |
First Address | Wellington, KS 67152-2812 |
Second Address | Wellington, KS 67152-2812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U88467 | (02) | KS |