| Doctor Name: | DR. STACEY B GILLIS |
| NPI Number: | 1497780225 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.C. |
| License Number: | DC28079 |
| Business Practice Address: | 2200 Harbor Blvd Ste B160 Costa Mesa, CA - 926275871 |
| Business Phone Number: | 9495155170 |
| Business Fax Number: | 9495155173 |
| Mailing Address: | 2200 Harbor Blvd Ste B160, COSTA MESA |
| State: | CA |
| Postal Code: | 926275871 |
| Phone Number: | 9495155170 |
| Fax Number: | 9495155173 |
| NPI Enumeration Date: | 07/11/2006 |
| NPI Last Update Date: | 08/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111N00000X |
| License Number: | DC28079 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |