Provider Demographics
NPI:1992793905
Name:GILCHER, CHARLES MATTHEW (DC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MATTHEW
Last Name:GILCHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 FORT ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2428
Mailing Address - Country:US
Mailing Address - Phone:313-928-2777
Mailing Address - Fax:313-928-2825
Practice Address - Street 1:3030 FORT ST
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2428
Practice Address - Country:US
Practice Address - Phone:313-928-2777
Practice Address - Fax:313-928-2825
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301006168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI143224525Medicaid
MI950H234910OtherBCBSM
MIU51766OtherHAP
MI383277909OtherCOMMERCIAL
MI950H253200OtherBCBSM
MIU51766Medicare UPIN
MI950H253200OtherBCBSM