MEDICARE: CHARLES M. GILCHER D.C., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	950H253200	OTHER	MI	BCBSM
2	U51766	OTHER	MI	HAP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	950H234910	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1801083035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES M. GILCHER D.C., P.C.

Provider Business Mailing Address
First Line	:	3030 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2428
Country	:	US
Telephone Number	:	313-928-2777
Fax Number	:	313-928-2825

Provider Business Practice Location Address
First Line	:	3030 FORT ST
Second Line	:
City	:	LINCOLN PARK
State	:	MI
Zip	:	48146-2428
Country	:	US
Telephone Number	:	313-928-2777
Fax Number	:	313-928-2825

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES MATTHEW GILCHER
Credential	:	D.C.
Telephone Number	:	313-928-2777

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	12/09/2011

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