MEDICARE: KELLIE JEAN GILLIS DC

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	2301009040	MI

General Provider Information

NPI Number	:	1962421289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE JEAN GILLIS DC

Provider Business Mailing Address
First Line	:	8 S 11TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1504
Country	:	US
Telephone Number	:	906-428-2225
Fax Number	:	906-428-9778

Provider Business Practice Location Address
First Line	:	8 S 11TH ST
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-1504
Country	:	US
Telephone Number	:	906-428-2225
Fax Number	:	906-428-9778

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/29/2016

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Directions to “ KELLIE JEAN GILLIS DC” Practice Location

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