MEDICARE: KENNETH GILMORE DC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NN0400X	Neurology Chiropractor
2	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH13817	OTHER	FL	FLORIDA BOARD OF MEDICINE

General Provider Information

NPI Number	:	1619150901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH GILMORE DC PA

Provider Business Mailing Address
First Line	:	800 VIRGINIA AVE STE 45
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	772-466-9575
Fax Number	:	772-466-9475

Provider Business Practice Location Address
First Line	:	800 VIRGINIA AVE STE 45
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5893
Country	:	US
Telephone Number	:	772-466-9575
Fax Number	:	772-466-9475

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KERRI GILMORE
Credential	:
Telephone Number	:	772-834-6019

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	07/02/2025

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Directions to “KENNETH GILMORE DC PA ” Practice Location

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