Healthcare Provider Details

I. General information

NPI: 1245481712
Provider Name (Legal Business Name): GANTOS CHIROPRACTIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6045 CORUNNA RD SUITE A
FLINT MI
48532-5302
US

IV. Provider business mailing address

6045 CORUNNA RD SUITE A
FLINT MI
48532-5302
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-5211
  • Fax: 810-733-5849
Mailing address:
  • Phone: 810-733-5211
  • Fax: 810-733-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDG005406
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID JOHN GANTOS
Title or Position: OWNER
Credential: D.C.
Phone: 810-733-5211