Provider Demographics
NPI:1235754797
Name:GEARHEART, MICHAEL MACKENZIE (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MACKENZIE
Last Name:GEARHEART
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 1:13991 AVALON EAST DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-6211
Mailing Address - Country:US
Mailing Address - Phone:765-499-8376
Mailing Address - Fax:
Practice Address - Street 1:13991 AVALON EAST DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-6211
Practice Address - Country:US
Practice Address - Phone:765-499-8376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003161A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor