Provider Demographics
NPI:1154574028
Name:FARAGE, GERARD EDWARD (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:EDWARD
Last Name:FARAGE
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 1:1715 4 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2440
Mailing Address - Country:US
Mailing Address - Phone:616-447-8577
Mailing Address - Fax:616-447-8611
Practice Address - Street 1:1715 4 MILE RD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-2440
Practice Address - Country:US
Practice Address - Phone:616-447-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC23160111NI0013X
MI2301007051111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner