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General NPI Number Information
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NPI Number | 1215903083
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Entity Type | Individual
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Provider Name | JEFFREY THOMAS GISCHIA DC
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 100 N ROLAND ST
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City | MC BAIN
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State | MI
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Zip | 49657-9683
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Country | US
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Telephone | 231-825-8143
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Fax | 231-825-0356
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Provider Business Mailing Address
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Address Line | 100 N ROLAND ST PO BOX 207
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City | MCBAIN
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State | MI
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Zip | 49657
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Country | US
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Telephone | 231-825-8143
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Fax | 231-825-0356
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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 | JG006101
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License Number State | MI
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