Provider Demographics
NPI:1629087416
Name:GILBERT CHIROPRACTIC CLINIC P C
Entity Type:Organization
Organization Name:GILBERT CHIROPRACTIC CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-765-4100
Mailing Address - Street 1:6640 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-2251
Mailing Address - Country:US
Mailing Address - Phone:810-765-4100
Mailing Address - Fax:810-765-4130
Practice Address - Street 1:6640 RIVER RD
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-2251
Practice Address - Country:US
Practice Address - Phone:810-765-4100
Practice Address - Fax:810-765-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3171271Medicaid
MI3171271Medicaid
MIU56868Medicare UPIN