Provider Demographics
NPI:1538366042
Name:O'BRIEN FAMILY CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:O'BRIEN FAMILY CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:231-744-6400
Mailing Address - Street 1:1519 E RIVER RD
Mailing Address - Street 2:STE. B
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-8591
Mailing Address - Country:US
Mailing Address - Phone:231-744-6400
Mailing Address - Fax:231-744-6464
Practice Address - Street 1:1519 E RIVER RD
Practice Address - Street 2:STE. B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-8591
Practice Address - Country:US
Practice Address - Phone:231-744-6400
Practice Address - Fax:231-744-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836767Medicaid
MIV06496Medicare UPIN
MI0P22120Medicare ID - Type Unspecified