Healthcare Provider Details

I. General information

NPI: 1780132977
Provider Name (Legal Business Name): JESSE B GILLHAM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 3RD ST STE 110
HENDERSON KY
42420-5802
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 270-770-5520
  • Fax: 844-331-2800
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-492-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003130A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: