Provider Demographics
NPI:1346429016
Name:CHIROPRACTIC CENTER OF PETOSKEY PC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF PETOSKEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PATEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-347-7272
Mailing Address - Street 1:205 W MITCHELL
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2325
Mailing Address - Country:US
Mailing Address - Phone:231-347-7272
Mailing Address - Fax:231-347-7414
Practice Address - Street 1:205 W MITCHELL
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2325
Practice Address - Country:US
Practice Address - Phone:231-347-7272
Practice Address - Fax:231-347-7414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGP008342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83870Medicare UPIN
ON61040Medicare PIN