Provider Demographics
NPI:1083021208
Name:GAVRON, DAVID PHILIP
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PHILIP
Last Name:GAVRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5829 W MAPLE RD
Mailing Address - Street 2:SUITE 123
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2294
Mailing Address - Country:US
Mailing Address - Phone:248-737-8066
Mailing Address - Fax:248-757-2209
Practice Address - Street 1:5829 W MAPLE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2294
Practice Address - Country:US
Practice Address - Phone:248-737-8066
Practice Address - Fax:248-757-2209
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor