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General NPI Number Information
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NPI Number | 1023312774
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Entity Type | Organization
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Legal Business Name | GILLIS FAMILY CHIROPRACTIC INC.
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Dates
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Enumeration Date | 01/10/2011
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 5675 BURLINGAME AVE. SUITE A
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City | WYOMING
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State | MI
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Zip | 49509-9702
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Country | US
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Telephone | 616-538-2200
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Fax | 616-301-0419
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Provider Business Mailing Address
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Address Line | 5675 BURLINGAME AVE. SUITE A
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City | WYOMING
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State | MI
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Zip | 49509
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Country | US
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Telephone | 616-538-2200
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Fax | 616-301-0419
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Authorized Official
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Title or Position | OWNER
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Name | DR. BENJAMIN DAVID GILLIS
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Credential | D.C.
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Telephone | 616-538-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301008777
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License Number State | MI
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