Provider Demographics
NPI:1316903826
Name:GILLIAM, PAULA DEAN (DC)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:DEAN
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:GILLIAM
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1900A SPARKMAN DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1124
Mailing Address - Country:US
Mailing Address - Phone:256-430-0021
Mailing Address - Fax:256-830-1364
Practice Address - Street 1:1900A SPARKMAN DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1124
Practice Address - Country:US
Practice Address - Phone:256-430-0021
Practice Address - Fax:256-830-1364
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0961111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68423Medicare UPIN