Provider Demographics
NPI:1760508246
Name:GATEWAY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:GATEWAY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-242-4422
Mailing Address - Street 1:14930 LAPLAISANCE RD STE 134
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3898
Mailing Address - Country:US
Mailing Address - Phone:734-242-4422
Mailing Address - Fax:734-242-6774
Practice Address - Street 1:14930 LAPLAISANCE RD STE 134
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3898
Practice Address - Country:US
Practice Address - Phone:734-242-4422
Practice Address - Fax:734-242-6774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3U77862Medicare UPIN
MI0P30950Medicare ID - Type Unspecified