Healthcare Provider Details

I. General information

NPI: 1174601306
Provider Name (Legal Business Name): ROBERT ALLAN GOSNELL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9019 W BELDING RD
BELDING MI
48809-9280
US

IV. Provider business mailing address

9019 W BELDING RD
BELDING MI
48809-9280
US

V. Phone/Fax

Practice location:
  • Phone: 616-794-3540
  • Fax: 616-794-3595
Mailing address:
  • Phone: 616-794-3540
  • Fax: 616-794-3595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004575
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: