Provider Demographics
NPI:1124453360
Name:GASIEWICZ, MICHAEL JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:GASIEWICZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37037 TWIN CT
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2178
Mailing Address - Country:US
Mailing Address - Phone:586-265-1260
Mailing Address - Fax:
Practice Address - Street 1:27253 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2858
Practice Address - Country:US
Practice Address - Phone:586-459-5692
Practice Address - Fax:586-459-5635
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor