Healthcare Provider Details

I. General information

NPI: 1396141982
Provider Name (Legal Business Name): ALTERNATIVE HEALING CHIROPRACTIC CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49100 PONTIAC TRL
WIXOM MI
48393-2569
US

IV. Provider business mailing address

49100 PONTIAC TRL
WIXOM MI
48393-2569
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-1109
  • Fax: 248-669-2552
Mailing address:
  • Phone: 248-669-1109
  • Fax: 248-669-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301010239
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID PHILIP GAVRON
Title or Position: SOLE MEMBER
Credential: D.C.
Phone: 248-669-1109