MEDICARE: DR. DARRYL SEYMOUR GILIAM DC

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	111N00000X	Chiropractor	CH0004082	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891792016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL SEYMOUR GILIAM DC

Provider Business Mailing Address
First Line	:	3242 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4574
Country	:	US
Telephone Number	:	863-644-0880
Fax Number	:	863-644-4992

Provider Business Practice Location Address
First Line	:	3242 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-4574
Country	:	US
Telephone Number	:	863-644-0880
Fax Number	:	863-644-4992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	12/19/2023

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