Provider Demographics
NPI:1740410158
Name:GABRYSHAK CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GABRYSHAK CHIROPRACTIC, INC
Other - Org Name:PREMIER CHIROPRACTIC ROCKFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:GABRYSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC,LCP
Authorized Official - Phone:815-227-9949
Mailing Address - Street 1:123 N ALPINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4980
Mailing Address - Country:US
Mailing Address - Phone:815-975-8644
Mailing Address - Fax:
Practice Address - Street 1:123 N ALPINE RD
Practice Address - Street 2:STE A
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4980
Practice Address - Country:US
Practice Address - Phone:815-227-9949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038008484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty