Provider Demographics
NPI:1386794063
Name:GILLMAN, CARL D (DC)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:GILLMAN
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 1:203 SCOTT COURT
Mailing Address - Street 2:SUITE 207
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:193-513-5413
Mailing Address - Fax:
Practice Address - Street 1:203 SCOTT COURT
Practice Address - Street 2:SUITE 207
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-351-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA45049OtherBLUE CROSSBLUE SHIELD
IA1268284Medicaid
IA1268284Medicaid