Healthcare Provider Details

I. General information

NPI: 1346366275
Provider Name (Legal Business Name): GARY A SHOEMAKER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18720 MACK AVE SUITE 120
GROSSE POINTE FARMS MI
48236-2993
US

IV. Provider business mailing address

18720 MACK AVE SUITE 120
GROSSE POINTE FARMS MI
48236-2993
US

V. Phone/Fax

Practice location:
  • Phone: 313-886-8030
  • Fax: 313-886-4350
Mailing address:
  • Phone: 313-886-8030
  • Fax: 313-886-4350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2301004518
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: