Healthcare Provider Details

I. General information

NPI: 1841642832
Provider Name (Legal Business Name): GORBACH FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 07/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 ALPINE AVE NW SUITE 2
COMSTOCK PARK MI
49321-8003
US

IV. Provider business mailing address

6440 ALPINE AVE NW SUITE 2
COMSTOCK PARK MI
49321-8003
US

V. Phone/Fax

Practice location:
  • Phone: 616-419-3399
  • Fax:
Mailing address:
  • Phone: 616-419-3399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301009613
License Number StateMI

VIII. Authorized Official

Name: JEFFREY GORBACH
Title or Position: OWNER/CHIROPRACTOR
Credential:
Phone: 231-638-0962