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General NPI Number Information
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NPI Number | 1124453360
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Entity Type | Individual
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Provider Name | MICHAEL JOHN GASIEWICZ D.C.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2013
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 27253 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2858
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Country | US
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Telephone | 586-459-5692
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Fax | 586-459-5635
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Provider Business Mailing Address
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Address Line | 37037 TWIN CT
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City | STERLING HEIGHTS
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State | MI
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Zip | 48312-2178
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Country | US
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Telephone | 586-265-1260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2301010119
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License Number State | MI
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