Provider Demographics
NPI:1265589683
Name:O'BRIEN, GABRIEL (BS, DC)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:BS, DC
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:O'BRIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSC, DC
Mailing Address - Street 1:1519 E RIVER RD
Mailing Address - Street 2:STE. B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8591
Mailing Address - Country:US
Mailing Address - Phone:231-744-6400
Mailing Address - Fax:231-744-6464
Practice Address - Street 1:1519 E RIVER RD
Practice Address - Street 2:STE. B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-8591
Practice Address - Country:US
Practice Address - Phone:231-744-6400
Practice Address - Fax:231-744-6464
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI20-2940144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836767Medicaid
MIVO6496Medicare UPIN
MI4836767Medicaid