Healthcare Provider Details

I. General information

NPI: 1003145871
Provider Name (Legal Business Name): HZ CHIRO GR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E BELTLINE AVE NE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

5020 E BELTLINE AVE NE
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-4448
  • Fax:
Mailing address:
  • Phone: 616-364-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number230100583
License Number StateMI

VIII. Authorized Official

Name: DR. CRAIG R GILLING
Title or Position: PRESIDENT
Credential: D.C.
Phone: 616-364-4448