Provider Demographics
NPI:1366957144
Name:GORGES, CANDACE C (DC MS)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:C
Last Name:GORGES
Suffix:
Gender:F
Credentials:DC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7890 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIRCH RUN
Mailing Address - State:MI
Mailing Address - Zip Code:48415-9232
Mailing Address - Country:US
Mailing Address - Phone:989-624-1060
Mailing Address - Fax:
Practice Address - Street 1:7890 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIRCH RUN
Practice Address - State:MI
Practice Address - Zip Code:48415-9232
Practice Address - Country:US
Practice Address - Phone:989-624-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010596111NR0400X, 111N00000X
MO2017030082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor