Provider Demographics
NPI:1174601306
Name:GOSNELL, ROBERT ALLAN (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:GOSNELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 W BELDING RD
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9280
Mailing Address - Country:US
Mailing Address - Phone:616-794-3540
Mailing Address - Fax:616-794-3595
Practice Address - Street 1:9019 W BELDING RD
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9280
Practice Address - Country:US
Practice Address - Phone:616-794-3540
Practice Address - Fax:616-794-3595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95OC45017OtherBLUE CROSS BLUE SHIELD
MI153728114Medicaid
MI900000722OtherPRIORITY HEALTH
MI153728114Medicaid
MI95OC45017OtherBLUE CROSS BLUE SHIELD