Provider Demographics
NPI:1841235694
Name:GATEWAY FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:GATEWAY FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LACHARITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:231-352-4447
Mailing Address - Street 1:52 PALCICH RD
Mailing Address - Street 2:PO BOX 1731
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-9602
Mailing Address - Country:US
Mailing Address - Phone:231-352-4447
Mailing Address - Fax:231-325-2279
Practice Address - Street 1:52 PALCICH RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-9602
Practice Address - Country:US
Practice Address - Phone:231-352-4447
Practice Address - Fax:231-325-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4462021Medicaid
MIU178503Medicare UPIN
MIOAO5026Medicare ID - Type Unspecified