Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 038-008367 | IL |
NPI | 1063477263 |
---|---|
Provider Name | Dr. Todd Anthony Gill |
First Address | Mount Carmel, IL 62863-1459 |
Second Address | Mount Carmel, IL 62863-1459 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 09/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350051877 | RAILROAD MEDICARE (01) | IL |
U68432 | (02) | IL |