Healthcare Provider Details

I. General information

NPI: 1376313346
Provider Name (Legal Business Name): MANDY GLOYESKE DC, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5958 FAIRFIELD RD
OXFORD OH
45056-1506
US

IV. Provider business mailing address

5958 FAIRFIELD RD
OXFORD OH
45056-1506
US

V. Phone/Fax

Practice location:
  • Phone: 513-441-5877
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM24050472
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberDC-04793
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: