Provider Demographics
NPI:1720115546
Name:TRAINER GILLIAM, KIMBERLY JOY (DC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JOY
Last Name:TRAINER GILLIAM
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 1:112 S FRASER ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-3849
Mailing Address - Country:US
Mailing Address - Phone:814-234-4383
Mailing Address - Fax:248-264-4383
Practice Address - Street 1:112 S FRASER ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-3849
Practice Address - Country:US
Practice Address - Phone:814-234-4383
Practice Address - Fax:248-264-4383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC004764L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor