Healthcare Provider Details

I. General information

NPI: 1548859549
Provider Name (Legal Business Name): GORGES LIFE CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7890 MAIN ST
BIRCH RUN MI
48415-9232
US

IV. Provider business mailing address

7890 MAIN ST
BIRCH RUN MI
48415-9232
US

V. Phone/Fax

Practice location:
  • Phone: 989-624-1060
  • Fax: 989-624-4407
Mailing address:
  • Phone: 989-624-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CANDACE C GORGES
Title or Position: OWNER
Credential: DC, MS
Phone: 989-624-1060