Healthcare Provider Details

I. General information

NPI: 1619150901
Provider Name (Legal Business Name): KENNETH GILMORE DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 VIRGINIA AVE STE 45
FORT PIERCE FL
34982-5893
US

IV. Provider business mailing address

800 VIRGINIA AVE STE 45
FORT PIERCE FL
34982-5893
US

V. Phone/Fax

Practice location:
  • Phone: 772-466-9575
  • Fax: 772-466-9475
Mailing address:
  • Phone: 772-466-9575
  • Fax: 772-466-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: KERRI GILMORE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 772-834-6019