Provider Demographics
NPI:1245481712
Name:GANTOS CHIROPRACTIC CENTER, P.C.
Entity type:Organization
Organization Name:GANTOS CHIROPRACTIC CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-733-5211
Mailing Address - Street 1:6045 CORUNNA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5302
Mailing Address - Country:US
Mailing Address - Phone:810-733-5211
Mailing Address - Fax:810-733-5849
Practice Address - Street 1:6045 CORUNNA RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5302
Practice Address - Country:US
Practice Address - Phone:810-733-5211
Practice Address - Fax:810-733-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDG005406111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0B51668OtherBCBSM
MI2627098Medicaid
MI2627098Medicaid