Provider Demographics
NPI:1265526750
Name:GYMER CHIROPRACTIC CLINIC PC
Entity type:Organization
Organization Name:GYMER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:MARIE JEANNE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-964-1441
Mailing Address - Street 1:1250 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49014
Mailing Address - Country:US
Mailing Address - Phone:269-964-1441
Mailing Address - Fax:269-964-0137
Practice Address - Street 1:1250 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014
Practice Address - Country:US
Practice Address - Phone:269-964-1441
Practice Address - Fax:269-964-0137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
950A310570OtherBCBS
G06732OtherBCN
MI0004472879Medicaid
0N22150Medicare ID - Type Unspecified