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General NPI Number Information
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NPI Number | 1275817918
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Entity Type | Individual
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Provider Name | SHANNON LEIGH GILMORE D.C.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2011
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Last Update Date | 03/02/2017
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Provider Practice Location Address
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Address Line | 821 E GRANT HWY STE E
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City | MARENGO
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State | IL
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Zip | 60152-3445
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Country | US
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Telephone | 847-708-5853
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Fax |
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Provider Business Mailing Address
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Address Line | 1176 SANDALWOOD LN
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-1638
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Country | US
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Telephone | 847-708-5853
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 038008695
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License Number State | IL
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