1063540383 NPI number — DR. KENNETH MICHAEL GABRIEL D.C.

Table of content: DR. KENNETH MICHAEL GABRIEL D.C. (NPI 1063540383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063540383 NPI number — DR. KENNETH MICHAEL GABRIEL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABRIEL
Provider First Name:
KENNETH
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063540383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 STILES RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-4808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-893-1013
Provider Business Mailing Address Fax Number:
603-893-1298

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-4808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-893-1013
Provider Business Practice Location Address Fax Number:
603-893-1298
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  632-0401 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 2584 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y36794 . This is a "BCBS OF MASS." identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com