Healthcare Provider Details

I. General information

NPI: 1215903083
Provider Name (Legal Business Name): JEFFREY THOMAS GISCHIA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ROLAND ST
MC BAIN MI
49657-9683
US

IV. Provider business mailing address

100 N ROLAND ST PO BOX 207
MCBAIN MI
49657
US

V. Phone/Fax

Practice location:
  • Phone: 231-825-8143
  • Fax: 231-825-0356
Mailing address:
  • Phone: 231-825-8143
  • Fax: 231-825-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberJG006101
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: