Provider Demographics
NPI:1609872464
Name:GABRIEL, ROBERT (DC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GABRIEL
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 1:758 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
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007693111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI099-1528OtherHEALTHPLUS
MI950G950090OtherBSBSM
MIU75201Medicare UPIN
MI950G950090OtherBSBSM