Active NPI
Kimberly Joy Trainer Gilliam, D.C.
- Chiropractor
- State College, PA
National Provider Identifier
1720115546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC004764L
- Practice address
- 112 S Fraser St
State College, PA 16801-3849 - Phone
- (814) 234-4383
- Fax
- (248) 264-4383
- NPI assigned
- Feb 28, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | DC004764L | PA | Primary |
Addresses
Primary practice location
112 S Fraser St
State College, PA 16801-3849
Mailing address
112 S Fraser St
State College, PA 16801-3849
Phone (814) 234-4383
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DC004764L | PA | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415577600000",
"number": "1720115546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 S FRASER ST",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168013849",
"telephone_number": "814-234-4383",
"fax_number": "248-264-4383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 S FRASER ST",
"city": "STATE COLLEGE",
"state": "PA",
"postal_code": "168013849",
"telephone_number": "814-234-4383",
"fax_number": "248-264-4383"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRAINER GILLIAM",
"first_name": "KIMBERLY",
"middle_name": "JOY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-28",
"last_updated": "2014-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "PA",
"license": "DC004764L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in State College, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.