Provider Demographics
NPI:1841642832
Name:GORBACH FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GORBACH FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-638-0962
Mailing Address - Street 1:6440 ALPINE AVE NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-8003
Mailing Address - Country:US
Mailing Address - Phone:616-419-3399
Mailing Address - Fax:
Practice Address - Street 1:6440 ALPINE AVE NW
Practice Address - Street 2:SUITE 2
Practice Address - City:COMSTOCK PARK
Practice Address - State:MI
Practice Address - Zip Code:49321-8003
Practice Address - Country:US
Practice Address - Phone:616-419-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty