Healthcare Provider Details

I. General information

NPI: 1356502249
Provider Name (Legal Business Name): CHIROPRACTIC WELLNESS CENTER OF CARO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/13/2017
Certification Date:
Deactivation Date: 10/21/2008
Reactivation Date: 01/03/2017

III. Provider practice location address

758 N STATE ST
CARO MI
48723-1546
US

IV. Provider business mailing address

758 N STATE ST
CARO MI
48723-1546
US

V. Phone/Fax

Practice location:
  • Phone: 989-672-4141
  • Fax: 989-672-4040
Mailing address:
  • Phone: 989-672-4141
  • Fax: 989-672-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301007693
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT W GABRIEL
Title or Position: OWNER
Credential: D.C.
Phone: 989-672-4141