Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH9324 | FL |
N | 111N00000X | Chiropractor | DC-30080 | CA |
NPI | 1003985227 |
---|---|
Provider Name | Dr. John Blake Gilmore |
First Address | Pensacola, FL 32504-7145 |
Second Address | Pensacola, FL 32504-7145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 25/03/2015 |