Provider Demographics
NPI:1154423580
Name:GEISE, DAVID M (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:GEISE
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 1:913 W LOGAN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-2000
Mailing Address - Country:US
Mailing Address - Phone:419-586-8600
Mailing Address - Fax:419-586-7881
Practice Address - Street 1:913 W LOGAN ST
Practice Address - Street 2:SUITE E
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-2000
Practice Address - Country:US
Practice Address - Phone:419-586-8600
Practice Address - Fax:419-586-7881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1208111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06844166Medicaid
OH0605471Medicare ID - Type Unspecified
OH06844166Medicaid