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General NPI Number Information
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NPI Number | 1215583273
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Entity Type | Individual
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Provider Name | MARC A GUSSE DC
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Gender | Male
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Dates
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Enumeration Date | 08/15/2019
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 3845 IRIS DR
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City | WATERFORD TOWNSHIP
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State | MI
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Zip | 48329-1171
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Country | US
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Telephone | 517-410-0187
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Fax |
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Provider Business Mailing Address
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Address Line | 3845 IRIS DR
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City | WATERFORD TOWNSHIP
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State | MI
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Zip | 48329-1171
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Country | US
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Telephone | 517-410-0187
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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 | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 2301010838
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License Number State | MI
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