Provider Demographics
NPI:1558559740
Name:GENTLE TOUCH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GENTLE TOUCH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:BOWEN
Authorized Official - Last Name:GOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-667-6525
Mailing Address - Street 1:28051 DEQUINDRE RD STE F
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3016
Mailing Address - Country:US
Mailing Address - Phone:248-733-5442
Mailing Address - Fax:248-963-6214
Practice Address - Street 1:28051 DEQUINDRE RD STE F
Practice Address - Street 2:
Practice Address - City:MADISON HTS
Practice Address - State:MI
Practice Address - Zip Code:48071-3016
Practice Address - Country:US
Practice Address - Phone:248-733-5442
Practice Address - Fax:248-963-6214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKG006620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P14710Medicare PIN