Organization Active NPI

Gaston Family Chiropractic LLC

  • Chiropractor
  • Traverse City, MI
National Provider Identifier
1912028200
Registry record updated May 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301006073 Issued in MI
Legal business name
GASTON FAMILY CHIROPRACTIC LLC
Practice address
625 2ND St
Traverse City, MI 49684-2220
Phone
(231) 922-5060
Fax
(231) 922-5062
NPI assigned
Apr 3, 2007
Last updated
May 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert W Gaston, D.C.NPI 1518961499
Title
Owner
Phone
(231) 922-5060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2301006073 MI Primary

Addresses

Primary practice location

625 2ND St
Traverse City, MI 49684-2220

Mailing address

625 2ND St
Traverse City, MI 49684-2220
Phone (231) 922-5060

Other identifiers 1

IdentifierTypeStateIssuer
0B81220OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080414000079 MI Part B Supplier - Clinic/Group Practice 4284711383 Receives reassigned benefits from 3 practitioners
Practice locations: Traverse City, MI; Kalkaska, MI

National Provider Directory

National Provider Directory

Locations

108 Northland Plaza Rd
Kalkaska, MI 49646
Phone (231) 258-9874

13919 S West Bay Shore Dr
Ste G01
Traverse City, MI 49684
Phone (231) 929-7450

625 Second St
Traverse City, MI 49684
Phone (231) 922-5060

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209686400000",
    "number": "1912028200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 2ND ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842220",
            "telephone_number": "231-922-5060",
            "fax_number": "231-922-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 2ND ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842220",
            "telephone_number": "231-922-5060",
            "fax_number": "231-922-5062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-05-02",
        "status": "A",
        "authorized_official_last_name": "GASTON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-922-5060",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301006073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "0B81220",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.