Individual
DR. BENJAMIN DAVID GILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
5675 BURLINGAME AVE., SUITE A, WYOMING, MI 49509-9702
(616) 538-2200
(616) 301-0419
Mailing address
5675 BURLINGAME AVE., SUITE A, WYOMING, MI 49509-9702
(616) 538-2200
(616) 301-0419
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2301008777
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
950D113070
BLUE CROSS BLUE SHIELD
MI
01
—
ON84880
MEDICARE PTAN
MI
Enumeration date
04/18/2007
Last updated
11/08/2016
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