Provider Demographics
NPI:1215903083
Name:GISCHIA, JEFFREY THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:GISCHIA
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 1:100 N ROLAND ST
Mailing Address - Street 2:PO BOX 207
Mailing Address - City:MCBAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49657
Mailing Address - Country:US
Mailing Address - Phone:231-825-8143
Mailing Address - Fax:231-825-0356
Practice Address - Street 1:100 N ROLAND ST
Practice Address - Street 2:
Practice Address - City:MC BAIN
Practice Address - State:MI
Practice Address - Zip Code:49657-9683
Practice Address - Country:US
Practice Address - Phone:231-825-8143
Practice Address - Fax:231-825-0356
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJG006101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104181OtherPREFERRED CHOICES
GAP00040617OtherPALMETTO RAILROAD
MI950E710030OtherBCBS
MIP25758FOtherBCN-SE
MI143032269Medicaid
MI143032269Medicaid
GAP00040617OtherPALMETTO RAILROAD