Provider Demographics
NPI:1619678349
Name:CHIROTECHNOLOGIES CARE CENTER LLC
Entity Type:Organization
Organization Name:CHIROTECHNOLOGIES CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:WEDJAN
Authorized Official - Last Name:GAMET
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:231-799-2020
Mailing Address - Street 1:18400 N RIDGE CT APT 18
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-8941
Mailing Address - Country:US
Mailing Address - Phone:231-799-2020
Mailing Address - Fax:
Practice Address - Street 1:18400 N RIDGE CT APT 18
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-8941
Practice Address - Country:US
Practice Address - Phone:231-799-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty