Provider Demographics
NPI:1962551259
Name:GILMAN, PHILIP G (DC)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:G
Last Name:GILMAN
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 1:1964 RAHNCLIFF CT
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3003
Mailing Address - Country:US
Mailing Address - Phone:651-681-8199
Mailing Address - Fax:
Practice Address - Street 1:1964 RAHNCLIFF CT
Practice Address - Street 2:SUITE 600
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3003
Practice Address - Country:US
Practice Address - Phone:651-681-8199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1783OtherLICENSE
MN1783OtherLICENSE
MN350002674Medicare PIN