Provider Demographics
NPI:1649329129
Name:GILL, GURMIT (DC)
Entity type:Individual
Prefix:
First Name:GURMIT
Middle Name:
Last Name:GILL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 128TH ST SW
Mailing Address - Street 2:STE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6315
Mailing Address - Country:US
Mailing Address - Phone:425-347-8614
Mailing Address - Fax:425-348-6986
Practice Address - Street 1:927 128TH ST SW
Practice Address - Street 2:STE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6315
Practice Address - Country:US
Practice Address - Phone:425-347-8614
Practice Address - Fax:425-348-6986
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2029437Medicaid
WAU94969Medicare UPIN
WA2029437Medicaid