Provider Demographics
NPI:1184655912
Name:GEHEREN, MICHAEL JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:GEHEREN
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 1:2859 VIRGINIA BEACH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7622
Mailing Address - Country:US
Mailing Address - Phone:757-472-0630
Mailing Address - Fax:
Practice Address - Street 1:2859 VIRGINIA BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7622
Practice Address - Country:US
Practice Address - Phone:757-472-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053506428OtherGROUP NPI
VA1184655912OtherINDIVIGUAL NPI
VA1184655912OtherINDIVIGUAL NPI