Provider Demographics
NPI:1356502249
Name:CHIROPRACTIC WELLNESS CENTER OF CARO PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF CARO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:989-672-4141
Mailing Address - Street 1:758 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1546
Mailing Address - Country:US
Mailing Address - Phone:989-672-4141
Mailing Address - Fax:989-672-4040
Practice Address - Street 1:758 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1546
Practice Address - Country:US
Practice Address - Phone:989-672-4141
Practice Address - Fax:989-672-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2017-07-13
Deactivation Date:2008-10-21
Deactivation Code:
Reactivation Date:2017-01-03
Provider Licenses
StateLicense IDTaxonomies
MI2301007693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0G950090OtherBCBS
MI108119OtherGREAT LAKES
MI099-1528OtherHEALTHPLUS
MI099-1528OtherHEALTHPLUS