Provider Demographics
NPI:1326049339
Name:PILLOW, GWEN (DC)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:
Last Name:PILLOW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 ORANGE GROVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2915
Mailing Address - Country:US
Mailing Address - Phone:813-963-3055
Mailing Address - Fax:
Practice Address - Street 1:13301 ORANGE GROVE DR STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2915
Practice Address - Country:US
Practice Address - Phone:813-963-3055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2024-06-17
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
CADC29264111N00000X
FLCH13384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 29264OtherCA CHIROPRACTIC BOARD
FLCH13384OtherFLORIDA DEPARTMENT OF HEALTH
CA1058988OtherASH PROVIDER NO.
CADC 29264OtherCA CHIROPRACTIC BOARD
CA1058988OtherASH PROVIDER NO.
CAV04007Medicare UPIN