Provider Demographics
NPI:1679749105
Name:GILL CHIROPRACTIC CENTER INC.
Entity type:Organization
Organization Name:GILL CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:248-586-9167
Mailing Address - Street 1:3179 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1339
Mailing Address - Country:US
Mailing Address - Phone:248-586-9167
Mailing Address - Fax:810-225-4630
Practice Address - Street 1:3179 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1339
Practice Address - Country:US
Practice Address - Phone:248-586-9167
Practice Address - Fax:810-225-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty