MEDICARE: DANIEL CLARENCE GLEASON D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301002923	MI

General Provider Information

NPI Number	:	1811927171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL CLARENCE GLEASON D.C.

Provider Business Mailing Address
First Line	:	19084 N FRUITPORT RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-1163
Country	:	US
Telephone Number	:	616-846-5410
Fax Number	:	616-846-3585

Provider Business Practice Location Address
First Line	:	19084 N FRUITPORT RD
Second Line	:
City	:	SPRING LAKE
State	:	MI
Zip	:	49456-1163
Country	:	US
Telephone Number	:	616-846-5410
Fax Number	:	616-846-3585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	06/16/2015

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