Individual ProviderBenjamin David GillisChiropractorChiropractic ProvidersPractice Address5675 Burlingame Ave., Suite A, Wyoming, MI 49509-9702(616) 538-2200PECOS EnrollmentBased on the most recent information from CMS, provider Benjamin David Gillis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1356567358Provider TypeIndividualFull NameGillis, Benjamin DavidTitleDr.CredentialDCGenderMaleSole ProprietorYesEnumeration Date4/18/2007Last Updated11/8/2016Contact InformationPractice LocationPractice Address5675 Burlingame Ave., Suite A, Wyoming, MI 49509-9702Phone(616) 538-2200Fax(616) 301-0419Mailing LocationMailing Address5675 Burlingame Ave., Suite A, Wyoming, MI 49509-9702Phone(616) 538-2200Fax(616) 301-0419Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicense2301008777MichiganProvider IdentifiersIDDescriptionIssuerID950D113070DescriptionOtherIssuerBLUE CROSS BLUE SHIELDMichiganIDON84880DescriptionOtherIssuerMEDICARE PTANMichigan