Provider Demographics
NPI:1023028826
Name:CIOLEK, GARY R (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
Last Name:CIOLEK
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 1:40580 VAN DYKE AVE
Mailing Address - Street 2:STE. A
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-3747
Mailing Address - Country:US
Mailing Address - Phone:586-978-1100
Mailing Address - Fax:586-978-9418
Practice Address - Street 1:40580 VAN DYKE AVE
Practice Address - Street 2:STE. A
Practice Address - City:STERLING HTS
Practice Address - State:MI
Practice Address - Zip Code:48313-3747
Practice Address - Country:US
Practice Address - Phone:586-978-1100
Practice Address - Fax:586-978-9418
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002992111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E05171OtherBLUE CROSS BLUE SHIELD
MI0E05171Medicare PIN