Provider Demographics
NPI:1154438042
Name:GINGRAS, MICHELLE LYNN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNN
Last Name:GINGRAS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 S RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3547
Mailing Address - Country:US
Mailing Address - Phone:386-767-6602
Mailing Address - Fax:386-767-6602
Practice Address - Street 1:3113 S RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-3547
Practice Address - Country:US
Practice Address - Phone:386-767-6602
Practice Address - Fax:386-767-6602
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8584111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL88894Medicare ID - Type Unspecified