Healthcare Provider Details

I. General information

NPI: 1255540332
Provider Name (Legal Business Name): YPSILANTI CHIROPRACTIC LIFE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 ECORSE RD
YPSILANTI MI
48198-5822
US

IV. Provider business mailing address

PO BOX 980709
YPSILANTI MI
48198-0709
US

V. Phone/Fax

Practice location:
  • Phone: 734-482-8005
  • Fax: 734-482-8006
Mailing address:
  • Phone: 734-482-8005
  • Fax: 734-482-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301002421
License Number StateMI

VIII. Authorized Official

Name: DR. ROBERT L GEHLY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 734-482-8005