Provider Demographics
NPI:1518961499
Name:GASTON, ROBERT WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:GASTON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 2ND ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2220
Mailing Address - Country:US
Mailing Address - Phone:231-922-5060
Mailing Address - Fax:231-922-5062
Practice Address - Street 1:625 2ND ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2220
Practice Address - Country:US
Practice Address - Phone:231-922-5060
Practice Address - Fax:231-922-5062
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-07-25
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
MI2301006073111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP87962OtherBLUE CARE NETWORK
MI0B85444OtherBCBS OF MI
MI3085520Medicaid
MIT97177Medicare UPIN
MIB85444001Medicare PIN