Provider Demographics
NPI:1831307487
Name:ABCG, LLC
Entity Type:Organization
Organization Name:ABCG, LLC
Other - Org Name:SUMMER AVE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:GANGWISH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:901-763-2225
Mailing Address - Street 1:4239 SUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4046
Mailing Address - Country:US
Mailing Address - Phone:901-763-2225
Mailing Address - Fax:901-682-4569
Practice Address - Street 1:4239 SUMMER AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4046
Practice Address - Country:US
Practice Address - Phone:901-763-2225
Practice Address - Fax:901-682-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000000782111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNU28749Medicare UPIN