Individual provider Active NPI

Nicole Antionette Gilliam, DC

  • Chiropractor
  • Concord, NC
National Provider Identifier
1902831589
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3475 Issued in NC
Practice address
86 Wilkinson CT SE
Concord, NC 28025-3543
Phone
(704) 795-1033
Fax
(704) 795-1069
NPI assigned
Jul 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3475 NC Primary

Addresses

Primary practice location

86 Wilkinson CT SE
Concord, NC 28025-3543

Mailing address

86 Wilkinson CT SE
Concord, NC 28025-3543
Phone (704) 795-1033

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080429000795 NC Practitioner - Chiropractic 2769561976

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College - West, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

86 Wilkinson CT SE
Concord, NC 28025-3543
Phone (704) 795-1033

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1902831589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 WILKINSON CT SE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280253543",
            "telephone_number": "704-795-1033",
            "fax_number": "704-795-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 WILKINSON CT SE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280253543",
            "telephone_number": "704-795-1033",
            "fax_number": "704-795-1069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "NICOLE",
        "middle_name": "ANTIONETTE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-11",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3475",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.