Provider Demographics
NPI:1033563242
Name:STRUCTURE & FUNCTION
Entity Type:Organization
Organization Name:STRUCTURE & FUNCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:GEISEMAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DC
Authorized Official - Phone:248-497-1034
Mailing Address - Street 1:595 FOREST AVE
Mailing Address - Street 2:SUITE- 7B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1775
Mailing Address - Country:US
Mailing Address - Phone:734-335-3635
Mailing Address - Fax:
Practice Address - Street 1:595 FOREST AVE
Practice Address - Street 2:SUITE- 7B
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1775
Practice Address - Country:US
Practice Address - Phone:734-335-3635
Practice Address - Fax:734-212-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty