Provider Demographics
NPI:1396141982
Name:ALTERNATIVE HEALING CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:ALTERNATIVE HEALING CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:GAVRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-669-1109
Mailing Address - Street 1:49100 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-2569
Mailing Address - Country:US
Mailing Address - Phone:248-669-1109
Mailing Address - Fax:248-669-2552
Practice Address - Street 1:49100 PONTIAC TRL
Practice Address - Street 2:
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-2569
Practice Address - Country:US
Practice Address - Phone:248-669-1109
Practice Address - Fax:248-669-2552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010239111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty