Provider Demographics
NPI:1548859549
Name:GORGES LIFE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:GORGES LIFE CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GORGES
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:989-624-1060
Mailing Address - Street 1:7890 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9232
Mailing Address - Country:US
Mailing Address - Phone:989-624-1060
Mailing Address - Fax:
Practice Address - Street 1:7890 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9232
Practice Address - Country:US
Practice Address - Phone:989-624-1060
Practice Address - Fax:989-624-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty