MEDICARE: JENNIFER GILMORE D.C.

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	X012901-1	NY

General Provider Information

NPI Number	:	1710422977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GILMORE D.C.

Provider Business Mailing Address
First Line	:	2625 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1705
Country	:	US
Telephone Number	:	716-335-9711
Fax Number	:	716-335-9696

Provider Business Practice Location Address
First Line	:	2625 DELAWARE AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1705
Country	:	US
Telephone Number	:	716-335-9711
Fax Number	:	716-335-9696

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

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	12/27/2016

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