1821151036 NPI number — DR. GARY LYNN CARLINI DOCTOR OF CHIROPRACT

Table of content: DR. GARY LYNN CARLINI DOCTOR OF CHIROPRACT (NPI 1821151036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821151036 NPI number — DR. GARY LYNN CARLINI DOCTOR OF CHIROPRACT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLINI
Provider First Name:
GARY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DOCTOR OF CHIROPRACT
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:
1821151036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10489 GRAND RIVER RD
Provider Second Line Business Mailing Address:
STE D
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48116-6509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-227-3600
Provider Business Mailing Address Fax Number:
810-227-6350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5841 WHITMORE LAKE RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48116-2470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-227-3600
Provider Business Practice Location Address Fax Number:
810-227-6350
Provider Enumeration Date:
12/18/2006

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:  2301006873 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 950D71260 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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