Provider Demographics
NPI:1801083035
Name:CHARLES M. GILCHER D.C., P.C.
Entity type:Organization
Organization Name:CHARLES M. GILCHER D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:GILCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:313-928-2777
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H253200OtherBCBSM
MIU51766OtherHAP
MI3254525Medicaid
MI950H234910OtherBCBSM
MIU51766Medicare UPIN
MIU51766OtherHAP
MI950H253200OtherBCBSM