Provider Demographics
NPI:1144350729
Name:GILLIAM, JENNIFER CELESTE (DC)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CELESTE
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:150 SPRINGSIDE DRIVE
Mailing Address - Street 2:SUITE B200
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2473
Mailing Address - Country:US
Mailing Address - Phone:330-281-1238
Mailing Address - Fax:330-296-4434
Practice Address - Street 1:150 SPRINGSIDE DRIVE
Practice Address - Street 2:SUITE B200
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2473
Practice Address - Country:US
Practice Address - Phone:330-281-1238
Practice Address - Fax:330-296-4434
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3659111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4173142Medicare PIN